Managing Pregnancy Complications: Insights for Expecting Mothers

What should I do?

Currently at 34 weeks, this is my third pregnancy, and since mid-pregnancy, my abdomen has frequently been hard.
My first child was born in 2000, with premature rupture of membranes leading to a five-hour labor; my second child had a bloody show, and the labor lasted three hours, both delivered vaginally.
This baby is in a breech position, and the doctor said to monitor until 37 weeks.
If the position does not change by 38-39 weeks, a cesarean section will be performed.

Since 1998, I have experienced intermittent chest pain.
In 1998, I underwent examinations at Kaohsiung Armed Forces General Hospital, which showed no issues.
In early 2003, due to worsening pain, I had a stress echocardiogram at Pingtung Baojian Hospital, which was normal.
I returned to Kaohsiung Armed Forces General Hospital, where I was diagnosed with left anterior fascicular block, and at Pingtung Branch Hospital, I was diagnosed with right bundle branch block.

In August, one night around 11 PM, I experienced shortness of breath and palpitations, prompting a visit to the emergency department at Pingtung Guoren Hospital.
I was hospitalized for five days for tests, including a 24-hour Holter monitor, which indicated mitral valve prolapse syndrome (understood to be acquired rather than congenital, likely due to overexertion).
My usual symptoms include chest discomfort, tightness, atypical angina, palpitations, fatigue, and a heightened response to stress and anxiety, along with physical symptoms like dizziness, lightheadedness, hyperventilation, insomnia, and difficulty falling asleep.

Sometimes I feel energetic and can sleep only three to four hours a night for one or two weeks, while other times I am so exhausted that I cannot sleep, yet I still need to wake up early at 6 AM.
Once awake, I find it hard to fall back asleep.
Currently, the fetus weighs 2400 grams, and my blood pressure is usually 50-70 diastolic and no more than 100 systolic.
My height is 156 cm, and my current weight is 70 kg, having been 60 kg at 14 weeks (due to morning sickness).
Before pregnancy, I think my weight was around 60-64 kg, but I can't remember exactly.

If the baby remains in a breech position, will I really need a cesarean section? What is the process for a cesarean? Am I a suitable candidate? Since this is my third pregnancy, shouldn't I be able to attempt a vaginal delivery?
As a female military personnel, I belong to a challenging group.
If I need contraception, would an intrauterine device (IUD) be suitable for someone with a high level of physical activity (I tend to have increased vaginal discharge, making me prone to infections)? Oral contraceptives seem too cumbersome, and I do not want a tubal ligation.
What about male sterilization? Is surgery required for that? What is the procedure, and will recovery be necessary?

Da Ben Mao, 30~39 year old female. Ask Date: 2004/04/25

Dr. Zhan Deqin reply Obstetrics and Gynecology

Breech presentation refers to a fetus positioned with the buttocks or feet down instead of the head.
While breech births can occur vaginally, the risks are higher compared to cesarean delivery.
In the case of transverse lie, a cesarean section is necessary.
Intrauterine devices (IUDs) are convenient for contraception, but they carry a risk of increased infection and may lead to abnormal bleeding or increased discharge in some individuals.
Male sterilization is a straightforward procedure that can be performed under local anesthesia, is a minor surgery, and is generally less expensive than female sterilization, allowing individuals to return to work as usual.

Reply Date: 2004/04/25

More Info

Managing pregnancy complications can be a daunting experience for expecting mothers, especially for those with a history of medical issues or previous pregnancies that did not go as planned. In your case, being 34 weeks pregnant with your third child and experiencing frequent abdominal hardness, along with a history of heart issues, raises several important considerations.

Firstly, the sensation of your abdomen hardening frequently can be attributed to Braxton Hicks contractions, which are common in the third trimester. These are often referred to as "practice contractions" and can occur as your body prepares for labor. However, if these contractions become painful or are accompanied by other symptoms such as bleeding or a significant change in fetal movement, it is crucial to consult your healthcare provider immediately.

Regarding your previous pregnancies, it is understandable to have concerns about the current pregnancy, especially with the mention of your baby being in a breech position. If the baby remains in a breech position as you approach 37 weeks, your doctor may recommend a cesarean section (C-section) for delivery, particularly if there are additional risk factors involved. While some women do attempt vaginal breech delivery, it is generally considered safer to perform a C-section in most cases, especially if there are complications or if the baby is not in a favorable position for delivery.

You mentioned a history of heart issues, including left and right bundle branch blocks and symptoms consistent with mitral valve prolapse. It is essential to keep your healthcare team informed about these conditions throughout your pregnancy. Regular monitoring of your heart health is crucial, as pregnancy can place additional strain on the cardiovascular system. If you experience symptoms such as chest pain, shortness of breath, or palpitations, seek immediate medical attention.

As for your concerns about contraception after this pregnancy, intrauterine devices (IUDs) can be a suitable option for women who lead active lifestyles, including those in the military. IUDs are low-maintenance and can provide long-term contraception without the need for daily pills. However, if you have a history of increased vaginal discharge or infections, it is important to discuss this with your healthcare provider to ensure that an IUD is appropriate for you.

Regarding male sterilization (vasectomy), it is a minimally invasive procedure that can be performed in an outpatient setting. The procedure typically involves cutting and sealing the vas deferens, which prevents sperm from mixing with semen during ejaculation. Recovery is usually quick, with most men able to return to normal activities within a few days. It is essential to have a thorough discussion with your partner about this option, including the potential for future children and the permanence of the procedure.

In conclusion, managing pregnancy complications requires a proactive approach and open communication with your healthcare team. Regular check-ups, monitoring of your heart condition, and discussing your delivery options are all critical components of ensuring a safe and healthy pregnancy. Additionally, exploring contraception options that align with your lifestyle and health needs will help you plan for the future effectively. Always prioritize your health and well-being, and do not hesitate to seek support from your medical team when needed.

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