3rd Prenatal Visit

Weight : 118 lbs/53 kilos
BP : 90/70.

I went to see my previous OB-Gyne this time because she's back from Manila where she had her specialty training on sonology. Of the 5 or more doctors I had seen for check-ups. she is the one so far I am completely at ease with. While the fact that she is my husband's family's friend might have helped, the truth is that she is one genuinely friendly person and she takes time to explain things to her patients. She is still young, around late 30's, and she heads the Women and Children's Protection Department of the regional hospital where she is also a resident doctor. Her name is Dr. Emily Ugdang.

It was just a routine prenatal visit, no serious findings to worry about except that of my weight. You see, I only gained 2 - 3 lbs in my entire first trimester. While this does not call for some serious remedy or treatment, things would have to be different in my case. You see, my second child was born with a congenital defect, duodenal atresia.

Here's a description of Doudenal Atresia, a defined by the UCL Institute of Child Health :

What is duodenal atresia?

Duodenal atresia means the
duodenum (first part of the small intestine just beyond the stomach) is closed off rather than being a tube. This stops food and fluid passing from the stomach into the
intestines.

How is it diagnosed?

Duodenal atresia can sometimes be discovered during pregnancy as it often shows up on antenatal ultrasound scanning. Some babies with this condition are born prematurely. Many babies appear well at birth but when they start to feed, they are sick and their vomit is green. An X-ray scan can confirm this diagnosis.

Duodenal atresia is a rare condition and occurs in about one in 10,000 births. It can be associated with other problems, so the doctors will examine your child closely to check if this is the case. One third of all children with duodenal atresia have Downs’ syndrome.

How is it treated?

Duodenal atresia is repaired in an operation under general anaesthetic (so your baby is deeply asleep), which lasts around 90 minutes.

Are there any alternatives?

No. Duodenal atresia always requires treatment to allow your baby to feed.

What happens before the operation?

Your baby will be transferred to the hospital soon after birth. To begin with, your child will be nursed in an incubator and will have a naso-gastric (NG) tube passed through his or her nose into the stomach. This will drain off the contents of the stomach and stop your child feeling and being sick. It also releases any excess air from the stomach, which could make your child uncomfortable. He or she will also have an intravenous infusion (drip) of fluids and medicines.

The surgeon will explain about the operation in more detail, discuss any worries you may have and ask you to sign a consent form giving permission for your child to have the operation. An anaesthetist will also visit you to explain about the anaesthetic.

What does the operation involve?

The surgeon will cut the blind end of the duodenum and connect it to the rest of the intestine. This provides a clear passage for food and fluid to travel from your child’s stomach to his or her intestine.

Are there any risks?

All the doctors who perform this operation have had lots of experience and will minimise the chance of problems occurring. All surgery carries a small risk of bleeding during or after the operation. Every anaesthetic carries a risk of complications, but this is very small. Your child’s anaesthetist is a very experienced doctor who is trained to deal with any complications.

What happens afterwards?

Your baby will come back to the ward to recover, and you will be able to visit as soon as he or she is settled back in the incubator. For a while after the operation, your baby will need help with breathing so will be connected to a ventilator. All babies are closely monitored after the operation, and so your baby will be connected to monitors to check his or her breathing, heart rate and oxygen levels. He or she will also be given pain relief through the intravenous infusion (drip).

While your child’s intestines recover and start to work, he or she will be fed through a tube into his or her veins (total parenteral nutrition or TPN). This will gradually be replaced by breast or bottled milk, given through the naso-gastric tube when your child is able to tolerate this. As your baby recovers, you will be able to feed him or her from the breast or bottle. Over time, the drips and monitors will be removed one by one.

The nurses on the ward will encourage you to look after your baby as much as you feel able while he or she is recovering. This can be daunting, especially while your baby is connected to drips and monitors, but it will become easier with time. If you are worried about caring for your baby, please talk to the nurses.

You will be able to go home or be transferred back to your local hospital once your baby is feeding properly and gaining weight. Your local health visitor or community paediatric nurse will visit you regularly. We will send you details of your outpatient appointment in the post, soon after you leave hospital.

Emergency

You should call your hospital if your baby:

• vomits when feeding

• has a swollen stomach

• vomits green liquid is not gaining weight

The doctors there will discuss any concerns with the team at Great Ormond Street Hospital.

But my son is doing fine now.

So, since I have a history of a difficult pregnancy, I have to take extra care of my and my unborn baby's health . Here's my doctor's orders:

1. Take an iron supplement;
2. Take a lot of sleep

My husband told my doctor how I spend too much time in front of the pc working, and
sleeping early in the morning (yes, at 2 or 3 a.m.), not getting an afternoon nap and rest while
my body clearly calls for it.

3. Eat some more and healthily

Hubby again reports to her how picky I can become with foods, not eating well, and eating lots
of junk like chocolates, softdrink, etc.

Target for next prenat visit : Gain at least 5 lbs.