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Ask The Expert: Dr. Patricia Connor Devine Talks Pregnancy

Dr. Patricia Connor Devine is the Director of Obstetrics and Gynecology for Lawrence Medical Associates and Director of the Maternal Child Health Center at Lawrence Hospital Center
Dr. Patricia Connor Devine is the Director of Obstetrics and Gynecology for Lawrence Medical Associates and Director of the Maternal Child Health Center at Lawrence Hospital Center Photo Credit: Contributed

Proper health management and regular doctor’s visits during a woman’s pregnancy can alert physicians to early warning signs of the challenges facing expecting mothers and babies.

Dr. Patricia Connor Devine, the Director of Obstetrics and Gynecology for Lawrence Medical Associates and Director of the Maternal Child Health Center at Lawrence Hospital Center, said one of the most common complications in pregnancy is preterm birth.

According to Dr. Devine, despite several advances in obstetric care over the years, preterm childbirth has been very difficult to eradicate due to multiple factors that contribute to it, ranging from infection, multiple gestation, cervical incompetence and maternal medical conditions such as diabetes and hypertension.  Preterm childbirth, defined as delivery prior to completion of a 37 week gestation period, occurs in 12% of all pregnancies annually and up to 20% annually for those with prior preterm births.

Dr. Devine said warning signs and symptoms of preterm labor include recurrent contractions, vaginal bleeding and increased vaginal pressure. “Several interventions are available to hopefully prevent preterm birth or improve the outcome if it were to occur,” she said.

Certain medications have been identified as being effective in the management of preterm labor and prevention of preterm birth. Uterine tocolytics, Dr. Devine said can cause a temporary decrease or cessation of contractions, to allow time for the administration of medications such as antenatal corticosteroids, Magnesium Sulfate and antibiotics, that can improve neonatal outcome.  They also can stabilize the patient to allow transfer of care to a tertiary care medical center, if that is indicated. Progesterone therapy has been identified as an effective intervention in preventing preterm birth for a subset  of patients who have been identified as being at risk for premature delivery; specifically those with a short cervix or a prior spontaneous preterm birth.

Hypertension, Dr. Devine said is defined as a systolic blood pressure above 140 mm Hg or a diastolic blood pressure greater than 90 mm Hg. While patients with hypertension may be asymptomatic, Dr. Devine said warning signs include severe headaches, blurred vision or seeing spots, nausea and vomiting. “Patients who develop these symptoms should notify their doctor and often times need immediate evaluation,” she said. Dr. Devine added that significant blood pressure changes are most often detected at routine doctor’s visits and stressed that compliance with prenatal office visits are critical to allow the opportunity for early diagnosis. She added that management of significant blood pressure disease varies and can become complicated depending on its severity and gestational age of the fetus. “Multiple medications are available that can be used to help control blood pressure, and are safe for use in pregnancy and breastfeeding,” she said.

Dr. Devine said fetal movement should also be routinely addressed as a sign of fetal well-being.  Beginning at 20 to 24 weeks gestation, patients should experience fetal movement periodically throughout the day. Fetal movement will become more pronounced as the baby grows.  In the third trimester, going a prolonged period, generally defined as greater than 6 hours, without any fetal movement should prompt further evaluation.  Periods of decreased fetal movement are most often secondary to fetal sleep cycle, however further evaluation is indicated to rule out more worrisome issues.

Dr. Devine said unfortunately, oftentimes complications of pregnancy cannot be avoided, but women can optimize the likelihood of having a healthy pregnancy by leading a healthy lifestyle before becoming pregnant. That lifestyle includes maintaining an ideal body weight, with good daily habits such as a healthy diet and exercise.

“Detrimental habits, such as tobacco, should be stopped prior to considering pregnancy,” she said.

Dr. Devine said the internet has become an excellent source for health information with many detailed sites on all aspects of pregnancy. She also recommended the classic book, “What to Expect When You’re Expecting,” by Lauren Effron, to help women understand the changes occurring in their bodies. “It provides very clear information to help answer a lot of the most common questions,” she said.

For more information, contact Dr. Devine at pdevine2@lawrencehealth.org or call (914) 787-3200.

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