WEBVTT - 208. Common Pregnancy Symptoms That May Not Be Normal 0:00:04.320 --> 0:00:07.400 Welcome to the Kick Your Expert led podcast, helping you 0:00:07.480 --> 0:00:11.879 explore and learn everything about getting pregnancy, birth, and becoming 0:00:11.880 --> 0:00:12.280 a parent. 0:00:12.640 --> 0:00:16.360 On the podcast and our online pregnancy program grow My Baby, 0:00:16.560 --> 0:00:19.480 we share my experience of helping more than four thousand 0:00:19.560 --> 0:00:20.720 babies to be born. 0:00:20.720 --> 0:00:23.360 And our experience of running a women's health clinic and 0:00:23.480 --> 0:00:24.520 parenting for boys. 0:00:24.760 --> 0:00:27.760 We're here to help everyone to feel empowered in pregnancy 0:00:27.880 --> 0:00:30.720 and birth with real life, practical information. 0:00:32.840 --> 0:00:34.959 Welcome everyone. I'm Bridget Maloney. 0:00:34.680 --> 0:00:37.720 And I'm obstetrician doctor Patrick, and today we. 0:00:37.720 --> 0:00:41.880 Thought we would cover a topic where you hear about 0:00:42.040 --> 0:00:44.800 pregnancy symptoms all the time, so you think that they're 0:00:44.800 --> 0:00:49.520 common and you make the assumption that they're normal. Sure, 0:00:50.440 --> 0:00:54.440 And part of that reason could be that we all 0:00:54.480 --> 0:00:57.600 want to be reassured. Yeah, so you say to your mate, oh, 0:00:57.640 --> 0:01:02.160 you know, I've got this really painful, sharp pain in 0:01:02.200 --> 0:01:04.679 my hips as I'm walking up the stairs or whatever, 0:01:04.720 --> 0:01:07.360 and your mate goes, oh, yeah, I'm sorry, love, you're 0:01:07.400 --> 0:01:07.839 just pregnant. 0:01:07.880 --> 0:01:10.319 You're pregnant. I had that, Yeah, yeah, I had that. 0:01:10.600 --> 0:01:12.760 That's the other thing people do is they reassured by 0:01:12.840 --> 0:01:14.520 saying it's okay, I had that. 0:01:14.720 --> 0:01:18.319 Ye, But there are some things that actually are potentially 0:01:18.360 --> 0:01:22.600 a sign of a serious issue in pregnancy that so 0:01:22.800 --> 0:01:26.000 they should be checked out. And what we as obstrics 0:01:26.080 --> 0:01:30.039 do is check that out for its potential serious cause 0:01:30.200 --> 0:01:31.960 and if it's not that, then maybe it is just 0:01:32.000 --> 0:01:33.160 because you're pregnant. 0:01:33.400 --> 0:01:35.360 All right, Patty, I want to start with something that 0:01:35.480 --> 0:01:39.160 I think is the most overlooked symptom of pregnancy, and 0:01:39.200 --> 0:01:42.360 that is the impact of pregnancy on your mental health. 0:01:43.520 --> 0:01:45.520 So this is a big one, isn't it. Because there 0:01:45.520 --> 0:01:51.160 are times when you you know you're pregnant, you're tired, 0:01:51.760 --> 0:01:55.400 there might be musculo schaletal pain, there might be anxiety 0:01:55.440 --> 0:01:58.760 about how the pregnancy is going. And there there would 0:01:58.800 --> 0:02:02.160 be some days, individual days when you might actually meet 0:02:02.200 --> 0:02:07.640 the diagnostic definition of someone with mental health issue, but 0:02:07.960 --> 0:02:09.960 it's just that day and you really are just pregnant. 0:02:11.080 --> 0:02:15.800 Other times the person complaining of those things actually does 0:02:15.880 --> 0:02:18.760 have a serious mental health issue. And we're going to 0:02:18.840 --> 0:02:22.280 work out, you know, who's tired and will be fine 0:02:22.320 --> 0:02:24.639 tomorrow and who's in trouble. 0:02:25.040 --> 0:02:27.920 Yeah, and those people that preps are in trouble, they 0:02:27.960 --> 0:02:30.240 don't come out with things like you know, I think 0:02:30.280 --> 0:02:33.960 I have anxiety or depression, or they don't say I 0:02:34.000 --> 0:02:38.560 feel like harming myself or I'm constantly thinking that there's 0:02:38.560 --> 0:02:41.400 something really wrong with my baby. They don't say that, 0:02:41.440 --> 0:02:41.680 do they. 0:02:41.919 --> 0:02:45.200 No, that's quite rare, really for someone to come out 0:02:45.200 --> 0:02:52.120 with an obvious, lay down MAS diagnosis, But they will 0:02:52.480 --> 0:03:02.720 often report a string of symptoms that, taken individually, could 0:03:02.800 --> 0:03:08.440 easily be dismissed as the ups and downs of pregnancy 0:03:08.720 --> 0:03:13.560 or a new parent, but looked at as a collection, 0:03:14.240 --> 0:03:15.840 you're going to stop, think twice and think, hang on 0:03:15.840 --> 0:03:19.160 a minute, are we missing a more significant issue here? 0:03:20.639 --> 0:03:23.560 So we can leave our audience with something if they 0:03:23.639 --> 0:03:26.920 feel that this is perhaps something that they've been just 0:03:27.120 --> 0:03:30.560 sneakily saying something to their partner or to their mother 0:03:30.760 --> 0:03:33.359 or sister or friend, or something about their mental health 0:03:33.400 --> 0:03:35.800 because they're a little bit worried about how they're feeling. 0:03:36.400 --> 0:03:41.760 What are some of the things that would make you 0:03:41.920 --> 0:03:45.400 want to investigate whether someone's mental health needs help. 0:03:46.040 --> 0:03:48.960 Yeah, it's a great question. There are a couple of 0:03:49.000 --> 0:03:53.320 different models. There's a thing called red flag model for 0:03:53.680 --> 0:03:57.600 mental illness, where there are some questions you can ask 0:03:58.040 --> 0:04:02.000 that are pretty much if those things are present, it's 0:04:02.040 --> 0:04:06.360 really never normal. So the big one is suicidal ideation. 0:04:06.840 --> 0:04:08.960 So if you're thinking about killing yourself all day, that's 0:04:09.000 --> 0:04:17.920 never normal and always highly significant. So you just have 0:04:17.960 --> 0:04:20.520 to get really comfortable with as a doctor with asking 0:04:20.560 --> 0:04:25.640 people whether they're planning to harm themselves or kill themselves. 0:04:26.200 --> 0:04:29.279 And the more the more you practice asking it, the 0:04:29.360 --> 0:04:32.400 easier it is to ask it. And no one's ever offended. 0:04:32.440 --> 0:04:35.600 They just say or even weirded out people often think, wow, 0:04:36.240 --> 0:04:39.000 good doctor's asked me that. And that's a good point. 0:04:40.320 --> 0:04:44.040 So it's the it's the care that has the awkwardness, 0:04:44.080 --> 0:04:47.120 not the patient. I've never had anyone stand up more 0:04:47.320 --> 0:04:49.960 going don't be ridiculous. People go, yeah, look now, thanks 0:04:49.960 --> 0:04:53.320 for asking that, because there are days when I've thought 0:04:53.360 --> 0:04:56.160 it might have been easier not to be here. And 0:04:56.200 --> 0:04:59.240 then we go, let's talk about this some more. You know, 0:04:59.320 --> 0:05:02.520 are you hoarding your medication to a term suicide? You know, 0:05:02.600 --> 0:05:07.240 so we press that, you know, for detail, and you know, 0:05:07.320 --> 0:05:09.919 and and and somebody who's doing that probably needs, you know, 0:05:10.400 --> 0:05:13.359 might need inpatient psychiatric care, whereas someone who just says 0:05:13.360 --> 0:05:16.159 some days it feels too hard and that person needs 0:05:16.200 --> 0:05:19.080 more support. But but but they're not they don't have 0:05:19.120 --> 0:05:23.640 mental illness, so so yeah, there are there are some 0:05:23.800 --> 0:05:29.320 red flag type questions. If people's mood is particularly bad, 0:05:29.920 --> 0:05:34.240 they'll often start to develop other symptoms, like a loss 0:05:34.240 --> 0:05:37.000 of appetite or something called early morning waking, when you 0:05:37.000 --> 0:05:38.839 wake up three o'clock in the morning prevously no reason, 0:05:38.960 --> 0:05:41.119 You're wide awaken, com back, can't get back to sleep, 0:05:42.080 --> 0:05:46.840 and these are features of depression, which which helped to 0:05:47.279 --> 0:05:51.200 tear help delineate the disease of depression from someone who's 0:05:51.240 --> 0:05:54.160 just having a bad run. And one of the problems 0:05:54.200 --> 0:05:58.560 with pregnancy and newborn care is they kind of overlap 0:05:58.600 --> 0:06:02.080 with normality a little bit because the breastfeeding mummy is 0:06:02.680 --> 0:06:05.960 up at night. It can be hard to prioritize your 0:06:05.960 --> 0:06:10.840 own epidity in the twenty four hour day phenomenon of 0:06:11.640 --> 0:06:14.560 you know, you've just come out of a complex hormonal 0:06:14.640 --> 0:06:16.680 environment of being pregnant and now you've got a twenty 0:06:16.680 --> 0:06:18.640 four hour day job looking after a baby. 0:06:19.560 --> 0:06:24.160 That is hard for the woman herself but also partners 0:06:24.640 --> 0:06:30.320 in how do they support their partner by saying, you know, well, 0:06:30.360 --> 0:06:33.680 I think this is just pregnancy hormones, or no, I 0:06:33.720 --> 0:06:37.039 think you need to discuss this further with your doctor. Yeah, 0:06:37.080 --> 0:06:38.839 like that that is very tricky. 0:06:38.960 --> 0:06:42.360 Yeah, we do rely on expertise, so nobody. I don't 0:06:42.400 --> 0:06:45.080 think anybody in the history of poor mental health has 0:06:45.080 --> 0:06:47.880 ever been pleased that they've got poor mental health. You know, 0:06:47.920 --> 0:06:49.400 we try and take the stigma out of it, but 0:06:49.440 --> 0:06:56.279 nobody wants it as a condition. So we need to 0:06:56.360 --> 0:07:02.279 be sort of reaching out to our support is more readily, 0:07:03.120 --> 0:07:07.440 and then the cares need to be asking that the 0:07:07.520 --> 0:07:09.920 right questions of everybody. 0:07:10.120 --> 0:07:15.840 Yeah, so that we started with that one that is 0:07:15.960 --> 0:07:19.480 common but not necessarily normal if you feel like you've 0:07:19.520 --> 0:07:22.680 got any of these things that we've just discussed. So 0:07:22.760 --> 0:07:25.760 that's our first good good. I want to move on 0:07:25.800 --> 0:07:28.880 to another one that I knew was not normal in 0:07:28.920 --> 0:07:32.640 my fourth pregnancy, Like I couldn't roll out over in 0:07:32.680 --> 0:07:37.520 bed without excruciating pain in my powers, or go upstairs 0:07:38.280 --> 0:07:42.920 or what was the other I want to kick the football, 0:07:43.240 --> 0:07:47.640 but probably shouldn't have been doing that anyway. I knew 0:07:47.680 --> 0:07:48.200 that was a problem. 0:07:48.240 --> 0:07:50.080 But if it's your first pregnancy, you might think this 0:07:50.160 --> 0:07:51.120 is just what being pregnant is. 0:07:51.200 --> 0:07:53.400 Yeah, because people say, oh, that's you know, that happened 0:07:53.400 --> 0:07:56.800 to me. It's just your ligament stretching, you know you'll 0:07:56.800 --> 0:07:57.240 get over it. 0:07:57.680 --> 0:08:04.360 Yep. So musculo scaletal pain. The where's the line between 0:08:04.400 --> 0:08:06.720 what to expect in pregnancy and what's an actual separate 0:08:06.720 --> 0:08:09.400 condition needing treatment. And I think it's one of functionality. 0:08:09.880 --> 0:08:13.120 So so when you're pregnant, you'll get some musculo sclidal pain, 0:08:13.360 --> 0:08:17.000 but give or take, you should be able to do 0:08:17.040 --> 0:08:19.240 the things that you need to do in that day. 0:08:19.600 --> 0:08:22.160 I know that's a broad statement, but you know, for 0:08:22.200 --> 0:08:24.320 the first for the first three cause of the pregnancy, 0:08:24.400 --> 0:08:26.320 someone who goes to work in an office and does 0:08:26.320 --> 0:08:29.080 a desk job, all things being equal, should be able 0:08:29.120 --> 0:08:32.360 to keep doing that. And if you if you literally 0:08:32.480 --> 0:08:35.240 can't you, if you can't walk, if you can't take 0:08:35.280 --> 0:08:39.079 yourself to a bathroom, then that's that's that's not normal, 0:08:39.160 --> 0:08:43.440 that that's a that's a condition that needs treatment and 0:08:43.559 --> 0:08:48.600 further examination. So we use we use a physiotherapists, and 0:08:49.160 --> 0:08:50.800 once or twice a year, I'll have someone with very 0:08:50.880 --> 0:08:53.720 very severe musculo scletal pain admitted to the hospital for care. 0:08:54.240 --> 0:08:59.120 Yeah, and it can happen like I remember not getting 0:08:59.120 --> 0:09:01.400 that pain until I was sort of in later pregnancy. 0:09:01.440 --> 0:09:04.480 Probably thirty weeks, thirty plus weeks and talking to somebody 0:09:04.520 --> 0:09:10.240 that got really bad pelvic pain in her early early 0:09:10.280 --> 0:09:13.080 on in the pregnancy, like eighteen weeks, and me thinking 0:09:13.120 --> 0:09:14.800 in my brain, I didn't say anything, but me thinking 0:09:14.840 --> 0:09:17.000 here my brain, well, you know, I'm not sure that 0:09:17.120 --> 0:09:21.800 that's that's normal, but her thinking it was you know, 0:09:21.960 --> 0:09:23.840 it can happen at different times. 0:09:24.559 --> 0:09:29.480 Yeah, absolutely, So again we ideally we're in a care situation, 0:09:30.600 --> 0:09:33.320 you know, obstetric care with the doctor, midwifree care with midwife. 0:09:33.320 --> 0:09:34.720 It's where we can say, is. 0:09:34.760 --> 0:09:35.720 This is this normal? 0:09:35.800 --> 0:09:39.000 Normal? This is what's happened to me, what you see 0:09:39.080 --> 0:09:41.280 happen to other people? Because your care will be good 0:09:41.280 --> 0:09:43.840 at that and go no like that, No, I don't 0:09:43.880 --> 0:09:47.240 see that at all. Yeah, most eighteen weeks are fine. 0:09:47.960 --> 0:09:51.960 What about early very early on? We do get lots 0:09:51.960 --> 0:09:56.920 of questions through the speak pipe about sort of pain, cramping, 0:09:57.040 --> 0:10:01.160 stretching early on. Yeah, that's something that is normal. 0:10:02.040 --> 0:10:04.959 Yes, yes it is, and it is normal. And the 0:10:05.160 --> 0:10:07.480 and again where does where's the line? The line is 0:10:07.520 --> 0:10:12.520 definitely if it's associated with bleeding. So someone who's someone 0:10:12.520 --> 0:10:14.360 who's you know, seven or eight weeks pregnant getting lot 0:10:14.360 --> 0:10:17.960 of pain ultrasound. And one of the great reasons, one 0:10:18.000 --> 0:10:20.679 of the great things of having ultrasound machines in our 0:10:20.679 --> 0:10:22.720 consulting rooms is he just reach for it and just 0:10:22.960 --> 0:10:25.000 then I needn't send the patient away for an ultrasound. 0:10:25.960 --> 0:10:28.080 So someone's getting a lot of pain. We want to 0:10:28.080 --> 0:10:29.719 make sure that the uterus, that the pregnancy is in 0:10:29.760 --> 0:10:31.760 the right place in the uterus, and we're not. We're 0:10:31.760 --> 0:10:34.240 not seeing someone who's got a neck topic or god forbid, 0:10:34.240 --> 0:10:38.240 a ruptured eck topic. And then and bleeding is a 0:10:39.040 --> 0:10:42.040 is a good line in the sand as well. It 0:10:42.040 --> 0:10:44.440 definitely shouldn't be bloody, all right. 0:10:44.480 --> 0:10:46.600 I want to run the next scenario by you, and 0:10:46.640 --> 0:10:49.640 that is we're hear it all the time, and I 0:10:49.720 --> 0:10:52.560 remember suffering from it too. Is headaches. 0:10:52.960 --> 0:10:53.440 Headaches. 0:10:53.640 --> 0:10:58.000 I pretty much had headaches all throughout my pregnancies, just 0:10:58.040 --> 0:11:01.199 to sort of my constant for and you know, your 0:11:01.200 --> 0:11:05.200 head feels sore, but it doesn't sort of go from there, 0:11:06.720 --> 0:11:11.200 pretty sure that that was just pregnancy. But when where's 0:11:11.200 --> 0:11:13.960 that line in the sand? When should you go, Okay, well, 0:11:14.080 --> 0:11:15.080 that isn't normal. 0:11:15.240 --> 0:11:19.520 So it's a great example because headache is really common 0:11:20.400 --> 0:11:23.839 and I don't know if it's accurate to call it normal. 0:11:23.920 --> 0:11:26.840 It's just really common, and it's common for it to 0:11:27.040 --> 0:11:33.760 not represent serious underlying disease. There are times in the 0:11:33.800 --> 0:11:38.439 pregnancy when progesterone output from the placenta is very high. 0:11:38.520 --> 0:11:41.560 It peaks from here, it peaks at certain predictable times, 0:11:41.840 --> 0:11:45.000 and headaches are more common. The problem is that headache 0:11:45.040 --> 0:11:49.160 can be a symptom of severe preclamps here, and so 0:11:49.400 --> 0:11:52.800 the line in the sand with headache is what's going 0:11:52.840 --> 0:11:55.960 with the rest of your body. Yeah, So the headache itself, 0:11:56.640 --> 0:11:59.360 it should not be unbearably severe, but a low level 0:11:59.400 --> 0:12:04.240 headache can be harmless. But it's what's going on with 0:12:04.280 --> 0:12:11.200 everything else. So is there associated visual disturbance? And what's 0:12:11.200 --> 0:12:12.920 the blood pressure and the urinalysis doing? 0:12:13.320 --> 0:12:13.560 Yeah? 0:12:13.679 --> 0:12:16.120 Yeah, So someone comes in a thirty weeks with headache, 0:12:16.160 --> 0:12:18.240 first thing I'm doing is taking their blood pressure, checking 0:12:18.280 --> 0:12:21.120 their ankles for swelling, and checking the urine for protein. 0:12:22.200 --> 0:12:25.040 If the headache is part of an onset of severe preclams, 0:12:25.080 --> 0:12:26.679 tour in their bloo pressure one hundred and sixty, one 0:12:26.760 --> 0:12:29.680 hundred and ten, that's preclaims here, and they need to 0:12:29.679 --> 0:12:31.800 be in the hospital and being worked up and managed. 0:12:32.600 --> 0:12:34.960 If everything else is normal and the headache is there, 0:12:35.120 --> 0:12:37.160 then we talk about managing the headache as best we can. 0:12:38.120 --> 0:12:42.679 Which we are in pregnancy allowed or able to take paracetamol. 0:12:42.960 --> 0:12:51.440 Yeah, yeah, paracetamol, increase fluids, you know, things like allied 0:12:51.480 --> 0:12:55.400 health treatments, massage to the neck, trigger point treatments, all 0:12:55.400 --> 0:12:58.920 sorts of things can be really good for headache. And 0:13:00.120 --> 0:13:01.880 things that we can do that are nice for ourselves, 0:13:01.880 --> 0:13:04.600 like get a pregnancy massage and things like that can 0:13:04.640 --> 0:13:08.840 all make low level, long standing headache and pregnancy more tolerable. 0:13:09.600 --> 0:13:12.240 But the number one thing we're gonna do is make 0:13:12.280 --> 0:13:14.760 sure that just because it's common doesn't mean it's normal, 0:13:15.080 --> 0:13:18.439 and we're not sitting on a headache as a manifestation 0:13:18.520 --> 0:13:20.000 of a more severe diagnosis. 0:13:20.240 --> 0:13:23.960 And if anyone is worried about taking paracetamol because of 0:13:24.000 --> 0:13:28.760 the claims made on social media that perhaps there's a 0:13:28.760 --> 0:13:30.520 link to autism, that is not true. 0:13:30.600 --> 0:13:33.720 That is not true, and it's been conclusively disproved. And 0:13:33.760 --> 0:13:36.520 we take our health advice from experts. 0:13:37.920 --> 0:13:40.400 I think anyone listening to this podcast are taking their 0:13:40.440 --> 0:13:42.600 advice from experts. That's what I would like to think, 0:13:44.640 --> 0:13:47.760 all Right, I'm going to run this scenario by you, 0:13:47.840 --> 0:13:50.520 and that is that you know, it's later in pregnancy 0:13:50.880 --> 0:13:52.640 and I'm sitting on the couch and I'm feeling a 0:13:52.640 --> 0:13:55.200 little bit short of breath, and people around me go, 0:13:55.280 --> 0:13:57.520 oh god, the baby's in the wrong positions. Just they're 0:13:57.559 --> 0:14:00.360 pushing up on your lung That happened to me. Yeah, no, 0:14:00.440 --> 0:14:02.560 wonder you're short of breath because you're running out of 0:14:02.600 --> 0:14:03.559 room there, look at your belly. 0:14:04.040 --> 0:14:06.880 Yeah. I think this is another good one, because sometimes 0:14:06.880 --> 0:14:10.200 it's normal and sometimes it's not. And the sort of 0:14:10.360 --> 0:14:13.320 shortness of breath that we should that we can experience 0:14:13.360 --> 0:14:17.320 in pregnancy and can be normal is a sort of 0:14:17.360 --> 0:14:20.920 a vague feeling that we can't quite catch our breath 0:14:21.920 --> 0:14:26.840 and a subtle feeling of being very mildly short of breath. 0:14:27.760 --> 0:14:32.160 And that's thought to be another progesterone effect, but it's 0:14:32.720 --> 0:14:35.400 it's not the same as somebody who literally literally can't 0:14:35.440 --> 0:14:39.920 get said breath. And the other thing we worry about 0:14:39.960 --> 0:14:43.840 with shortness of breath is a pulmonary embolus of blood 0:14:43.840 --> 0:14:47.760 clot in the lungs, and the typical textbook presentation of 0:14:48.040 --> 0:14:50.920 that is sudden nonset shortness of breath. So I was 0:14:50.920 --> 0:14:52.280 fine and then bang, I wasn't. 0:14:52.880 --> 0:14:56.520 Like when you say bang like straight away, like all 0:14:56.560 --> 0:14:57.040 of a sudden. 0:14:57.240 --> 0:15:00.240 Wow. Okay, so that's a blood clot potentially shifting from 0:15:00.280 --> 0:15:03.040 your legs to your lungs and suddenly, you know, in 0:15:03.080 --> 0:15:04.840 a matter of minutes, I was fine, and then I 0:15:04.920 --> 0:15:05.800 was then I was not. 0:15:06.200 --> 0:15:09.200 Yeah, I think that is a very definitive way of 0:15:09.240 --> 0:15:11.480 thinking about that I have. I didn't know that, so 0:15:11.560 --> 0:15:15.120 I I had always thought that a palmary embolism would 0:15:15.160 --> 0:15:18.240 cause like a gradual shortness of breath, and I would 0:15:18.280 --> 0:15:20.720 know that perhaps perhaps I've got an embolism. 0:15:21.240 --> 0:15:25.800 No, well, the textbook definition is sudden onset, and and 0:15:26.120 --> 0:15:28.280 you know, I guess a small one could cause something 0:15:28.360 --> 0:15:33.680 that was less dramatic or more more gradual. But it's 0:15:33.680 --> 0:15:36.600 typically seen in somebody who is who is sick, a 0:15:36.680 --> 0:15:42.800 hospital level type sick, and somebody who's had a vague 0:15:43.160 --> 0:15:45.880 pregnancy related shortness of breath that's been there for weeks 0:15:45.880 --> 0:15:51.120 but otherwise looks fine, needs needs. Some baseline investigations will 0:15:51.120 --> 0:15:52.680 put a little peek on your finger and measure the 0:15:52.680 --> 0:15:57.560 oxygen saturation. But if that's all normal, then then then 0:15:57.600 --> 0:16:00.720 we conclude that it's irritated but normal. 0:16:01.760 --> 0:16:05.480 I think with shortness of breath that I remember, like 0:16:05.760 --> 0:16:08.960 if you have exerted yourself physically, like you've just gone 0:16:09.000 --> 0:16:15.280 off three steps or you've quickly run after a toddler 0:16:15.400 --> 0:16:19.680 or something like that. Yes, that feeling is uncomfortable. That 0:16:19.680 --> 0:16:22.360 shortness of breath. It feels weird. It's something that you 0:16:22.440 --> 0:16:25.800 didn't have when you were not pregnant. But it's gone, 0:16:26.480 --> 0:16:27.400 like you just stopped for a. 0:16:27.360 --> 0:16:31.720 Tick results and results. Yeah, someone with pulmonary endless it 0:16:31.720 --> 0:16:32.600 doesn't settle with rest. 0:16:33.720 --> 0:16:37.240 Next, I want to talk about itching. Now, pregnancy for 0:16:37.320 --> 0:16:42.800 some people can be an itchy time. They feel irritated 0:16:42.840 --> 0:16:45.400 and they want to each sort of different parts of 0:16:45.440 --> 0:16:49.560 their body and stuff. But you know what people would say, 0:16:49.560 --> 0:16:53.200 because we instantly want to reassure someone, Oh, that's normal, 0:16:53.320 --> 0:16:56.440 it's just your skin stretching that happened to me. Put 0:16:56.480 --> 0:17:01.280 some whatever lotion on. What's going through your mind when 0:17:01.320 --> 0:17:02.080 you hear me say that. 0:17:03.040 --> 0:17:07.080 Well, there's one there's one or two severe causes of 0:17:07.119 --> 0:17:10.280 itch in pregnancy that we like to try and exclude. 0:17:10.320 --> 0:17:12.760 And sometimes it's possible to exclude it on the pattern, 0:17:14.160 --> 0:17:16.720 and other times we need to do some blood tests. 0:17:17.080 --> 0:17:19.160 So there's the things called a There's a thing called 0:17:19.160 --> 0:17:21.920 a pups rash, which is a raise ration. When you 0:17:21.960 --> 0:17:25.160 told me that needs some blood tests to make sure 0:17:25.200 --> 0:17:29.440 that the liver's working properly and has it and has 0:17:29.440 --> 0:17:32.399 an actual treatment and should be treated. There's another thing 0:17:32.440 --> 0:17:36.640 called coolystasis of pregnancy, which is a severe, potentially severe 0:17:37.320 --> 0:17:41.000 form of liver dysfunction in pregnancy that can be dangerous 0:17:41.000 --> 0:17:43.280 for the baby. And that needs a blood tests and 0:17:43.280 --> 0:17:47.359 it's got a treatment and investigations. And they both cause 0:17:47.920 --> 0:17:52.320 they both can cause a pattern of itchiness that might 0:17:52.680 --> 0:17:57.719 ring a bell to your care team. But some people 0:17:57.920 --> 0:18:01.760 just get itchy and some people, some women's stretch marks 0:18:01.760 --> 0:18:06.080 are itchy. Yeah, so we do take it seriously. Well, 0:18:06.480 --> 0:18:08.959 we would be asking about the pattern when did it 0:18:08.960 --> 0:18:12.000 come on? Is it on the soles of the feet 0:18:12.080 --> 0:18:14.359 and the palms of the hands, or is it on 0:18:14.480 --> 0:18:16.320 the tummy? Is it all over the tummy or just 0:18:16.359 --> 0:18:22.640 confined to the stretch marks. And then sometimes testing some 0:18:23.040 --> 0:18:27.360 liver function and some stuff some things called bilasses, which 0:18:27.440 --> 0:18:29.840 is just part of the function of the liver to 0:18:29.960 --> 0:18:32.600 make to make sure that those that it's not a 0:18:32.640 --> 0:18:36.800 more dangerous form of itch. So someone with a persistent, 0:18:36.920 --> 0:18:40.159 significant irritating itch in pregnancy, that's when we should be 0:18:40.200 --> 0:18:40.920 getting checked out. 0:18:41.400 --> 0:18:45.760 Yeah right, nice, Okay, well I want to move to 0:18:47.560 --> 0:18:52.000 I think it was Kim Kardashian's candles candles or just 0:18:52.040 --> 0:18:54.840 the feeling. You know, you sit around in your in 0:18:54.880 --> 0:18:57.560 your pregnancy, your prenatal group, and you sort of go, okay, 0:18:57.600 --> 0:19:00.760 well I can't fit my rings on anymore, or my 0:19:00.800 --> 0:19:02.919 feet aren't fitting into my shoes, or yes, I do 0:19:03.000 --> 0:19:06.840 have cankles, and everyone goes ha ha ha, So do 0:19:06.880 --> 0:19:07.440 I look at their. 0:19:09.080 --> 0:19:13.600 Yeah, that's a relatively easy one. The fluid that builds 0:19:13.680 --> 0:19:16.960 up on our body when we're pregnant, you can see 0:19:17.000 --> 0:19:19.960 it in the ankles, it's in your wrists as well, 0:19:19.960 --> 0:19:21.560 in your hands as well, which you can't quite see 0:19:21.560 --> 0:19:24.639 it quite as easily. It's pretty obvious when it builds 0:19:24.720 --> 0:19:26.720 up in the ankles, and if you spend a lot 0:19:26.760 --> 0:19:29.040 of time sitting, it'll build up around the around the 0:19:29.040 --> 0:19:31.720 sacram around the bottom of your back as well. And 0:19:32.400 --> 0:19:38.879 that is fluid that's building up. And the clencher is 0:19:38.880 --> 0:19:41.359 whether the blood pressure is also a problem. So if 0:19:41.359 --> 0:19:43.560 the blood pressure is perfectly normal, and there's no evidence 0:19:43.560 --> 0:19:45.399 of pretty clamsy. Then the swelling is what it is, 0:19:45.440 --> 0:19:48.760 and we try our best. We wear compression garments and 0:19:48.920 --> 0:19:53.120 do some fluid massage and keep active. Yeah, and wait 0:19:53.200 --> 0:19:55.199 until the baby you're more accurately the plus centa is 0:19:55.200 --> 0:19:56.960 out of the out of your body and then it'll 0:19:57.000 --> 0:20:02.080 go back to normal. H if if the if there's 0:20:02.080 --> 0:20:04.679 a lot of swelling in conjunction with high blood pressure, 0:20:04.760 --> 0:20:09.919 that's preclams here, that's serious dangerousneze treatment. So so check 0:20:09.960 --> 0:20:10.920 at blood pressure yep. 0:20:11.160 --> 0:20:14.280 And is it sudden that swelling does does you know, 0:20:14.320 --> 0:20:16.199 you might have a little bit of swelling, but if 0:20:16.240 --> 0:20:19.679 you've got preclamps here, does it sort of swell fast? 0:20:19.920 --> 0:20:22.560 No? No, So that's why we check the swelling at 0:20:22.600 --> 0:20:23.560 every anginatal visit. 0:20:23.600 --> 0:20:27.399 It can be subtle, and everybody should be having their 0:20:27.400 --> 0:20:29.160 blood pressure checked at every antenatal vision. 0:20:29.280 --> 0:20:31.879 Yeah, I mean, what's what's what's antenatal care for? What? 0:20:31.960 --> 0:20:34.359 It's not just to come in and you know, smile 0:20:34.359 --> 0:20:35.800 at your team, have them smile at you and say 0:20:35.800 --> 0:20:38.560 you good only for being pregnant. There's a point to everything, 0:20:39.359 --> 0:20:45.120 and and the antenat the big point of their trimester 0:20:45.240 --> 0:20:50.800 angenatal care. It's actually surveillance for preclams here and ensuring 0:20:50.840 --> 0:20:54.600 adequate federal growth. Yeah, there's other things, try and pick 0:20:54.640 --> 0:20:55.960 the babies that are trying to come out backwards and 0:20:55.960 --> 0:20:58.359 all sorts of things, but the big ticket once the 0:20:58.480 --> 0:21:01.920 things that have made a real different over the years 0:21:02.000 --> 0:21:06.359 to maternal health is picking pre clams here before you 0:21:06.440 --> 0:21:13.280 start fitting, yeah, and treating it with delivery, anti hypertensive drugs, 0:21:13.320 --> 0:21:18.119 hospital care before mum gets hick, and then picking fetal 0:21:18.119 --> 0:21:25.800 growth restriction before stillbirth. They that those interventions come out 0:21:25.840 --> 0:21:30.200 of good anti natal care. And you know, antiinatal care 0:21:30.320 --> 0:21:33.040 is a concept really only it's one hundred years old. 0:21:34.119 --> 0:21:37.160 It's funny, isn't it. So you know, I would wonder 0:21:37.160 --> 0:21:41.200 what everybody thinks anti natal care should be providing, because 0:21:42.359 --> 0:21:45.560 there might be just a gap there because if the 0:21:46.200 --> 0:21:49.760 practitioner is there going okay, gold standard is I'm checking 0:21:49.800 --> 0:21:53.359 blood pressure, I'm checking making sure there's adequate fetal growth, 0:21:53.760 --> 0:21:57.000 and the woman is coming in, And I would and 0:21:57.000 --> 0:22:00.320 this is what I expected, that that practitioner would be 0:22:00.400 --> 0:22:04.000 talking to me about other things like, you know, I 0:22:04.000 --> 0:22:07.199 don't know what supplements I should be on or my 0:22:07.440 --> 0:22:11.560 general health or so. I just wonder if that's where 0:22:11.560 --> 0:22:13.840 there's been a bit of a divide. 0:22:14.160 --> 0:22:17.200 Yes, I I don't know where to go, do you? 0:22:17.560 --> 0:22:19.280 I see what? No, I know, I see what you mean. 0:22:19.640 --> 0:22:21.560 And I'm not saying those other things shouldn't be done. 0:22:22.280 --> 0:22:25.600 I'm just saying that that that's that's what it was for. 0:22:25.720 --> 0:22:30.040 What it was invented for was to prevent poor obstetric outcomes, 0:22:31.000 --> 0:22:33.680 and it's still doing that. Sometimes it's not obvious to 0:22:33.800 --> 0:22:37.080 the woman having a normal progress that that's what her 0:22:37.160 --> 0:22:38.360 cares are doing in the background. 0:22:39.400 --> 0:22:42.800 I loved my obstration and a five minute checks like 0:22:42.840 --> 0:22:44.399 I was like you, beauty, I'm out of there. Ye 0:22:45.440 --> 0:22:46.160 want to hang out? 0:22:46.240 --> 0:22:48.800 Not everyone's there for the big check? No, no, yeah, 0:22:48.840 --> 0:22:51.520 And especially I noticed that the later I'm running, the 0:22:51.640 --> 0:22:53.040 less people are in for the big check. 0:22:53.200 --> 0:22:57.879