Dr Joseph Drentin is an Obstetrician and Gynaecologist with rooms located at St Vincent’s Private Hospital Fitzroy. Dr Drentin’s patients love his down to earth nature and his dedication to form personable relationships. His main interest is Obstetrics and he strives to provide individual high quality care to all of his patients. Dr Drentin is happy to provide obstetric care […]
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Dr Tang is a Monash graduate who has decided to pursue his specialty in Obstetrics and Gynaecology. He obtained his fellowship from The Royal Australian and New Zealand College of Obstetrics and Gynaecology in 2010. Dr Tang is also fluent in speaking Mandarin. Since then, Lloyd has embarked on a unique journey in order to enrich and refine his skills and […]
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Dr Guy Skinner is an established private obstetrician working in Melbourne, having moved to his new rooms onsite at St Vincent’s Private Hospital Melbourne. Guy has developed a busy practice over the past 12 years, with the added support of three highly experienced midwives. Guy strongly values natural birth and is well known for his open communication style and […]
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Dr John How consults as an Obstetrician and Gynaecologist at St Vincent’s Private Hospital, Fitzroy and at his private rooms in Spotswood (inner western suburb of Melbourne, 10 minutes from CBD). He has over 20 years experience in obstetrics and gynaecology, both in Melbourne and the United Kingdom. Whether this is your first baby or your fifth, Dr How is very […]
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Dr Joseph Sgroi is a private obstetrician and gynaecologist with consulting rooms in both East Melbourne and Werribee. Dr Sgroi has been providing health care to women for over seven years and has a breadth of experience in obstetrics and general gynaecology. Dr Sgroi completed three years of physician training at The Alfred Hospital; focusing on endocrinology, diabetic management and cardiology before […]
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Dr Lionel Steinberg is a private obstetrician and gynaecologist. Dr Steinberg manages very-high risk and complicated pregnancies and deliveries, specialises in multiple birth pregnancies and is encouraging of all pregnant women to choose to have a natural birth, minimising intervention when possible. Dr Steinberg’s rooms are located within St Vincent’s Private Hospital Melbourne. To contact Dr Steinberg’s rooms: Phone: 03 […]
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Dr Meredith Tassone runs a private obstetric and gynaecology clinic in Fitzroy. Meredith is assisted by a group of support staff who work together to ensure patient care is personal, with a strong focus on customer service. Meredith works as part of an all-female group of obstetricians. As the Head of an Obstetrics Unit at The Mercy Hospital for Women, […]
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Obstetrician Dr Vicki Nott cares for women throughout their pregnancy and birth, and is qualified to look after both uncomplicated and high risk pregnancies. Vicki is also a Gynaecologist who practices in all areas of gynaecology, with a particular interest in pre-pregnancy counselling. We asked Dr Nott to tell us a bit more about herself: I trained as a […]
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After three years of being busy looking after her own babies, Dr Miranda Robinson is back and excited to be joining the vibrant group of female obstetricians who all have a philosophy of providing their patients with personalised and holistic care. Dr Robinson is joining with Dr Vicki Nott, Dr Fiona Cowell and Dr Vanessa King
We asked Dr Robinson to tell us about her obstetric career:
Just to give you some background, I graduated from Otago University in 1994 and after 2 years working at Christchurch Public Hospital emigrated to Australia in February 1997.
I began my training in Obstetrics and Gynaecology at Monash Medical Centre in 1999 with rotations to Dandenong, Box Hill and Bendigo Base Hospitals. I was fortunate enough to be awarded the Gold Medal in the Membership Exams in 2002 and to complete my final years at the Mercy Hospital for Women in 2003 and at the Norfolk and Norwich University Hospital in England in 2004. It was here that I gained a great deal of Gynaecological experience in both Vaginal and Laparoscopic Surgery.
I currently hold public positions at both the Mercy and the Austin Hospitals in Heidelberg. At the Mercy I work in a General Obstetric unit and on Endo B Unit, which has a particular interest in menstrual disorders and minimally invasive surgery.
Since 2011 I have held the position of Medical Head of the Emergency Department at the Mercy.
I also work at the Austin on the Family Planning Unit, which also sees my consulting a small number of Adolescent Gynaecology patients.
Before having my two children I also worked in private practice for 5 years.
In my spare time I enjoy a good meal a good red and a good movie but most of all I enjoy time with my delightful 3 year old daughter and 1 year old son as well as my fabulous husband of course!
I look forward to assisting my patients with any queries and, especially in these early days, having the ability to see my patients at short notice.
Contact Dr Miranda Robinson:
Suite 5, 55 Victoria Parade, Fitzroy, Victoria 3065
(03) 9415 6077
Join Dr Miranda on Facebook
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While pregnancy and the months preparing for the arrival of a new baby can be exciting and filled with joy, many mums to be also experience the feeling of being fearful about giving birth.
Many of the fears regarding birth can be managed and being well informed and planning ahead can assist you to be less fearful.
Here’s a list of 12 of the most common fears from pregnant patients and tips on how you might be able to manage that fear.
Make sure you think about how long it will take you to get to the hospital at different times of the day, and who will be around to take you to hospital. Take a practice drive into the hospital so you know which way to go and where to park.
Read this post on what to do if you don’t think you are going to make it the hospital on time.
Make sure you have up to date Ambulance Victoria subscription
Having your baby at St Vincents private hospital with your own Obstetrician and a team of midwives caring for you should alleviate your worries
Talk to your Obstetrician and your partner if you have particular fears
All the antenatal care and investigations during the pregnancy and close observation during labour will minimise risk to your unborn baby
Scans and pregnancy testing is also a time when you are likely to discuss any aspects of your babies health.
Talk to your doctor and midwife about what you want and what you really don’t want.
It is important that you attend antenatal classes so that you can be educated about possibilities of what might happen during labour,
Don’t think ‘it won’t happen to me’– it might not, but it may well happen and it is best to be informed on what you would like to happen if you do require any level of intervention.
Firstly, remember this is a very common fear.
You are not going to be left in pain, you will have a team of people to support you through your labour. Your midwife will offer many suggestions at different times of your labour to help you manage any discomfort.
There are lots of options for pain relief during labour, speak with your obstetrician or midwife about what might be most appropriate at that particular stage of labour.
You might like to think about the types of pain relief you think you might like and talk to your obstetrician about it before the birth of your baby.
It is not unusual to fear being responsible for a tiny baby, especially if you have never had to care for one before.
Attending antenatal classes will provide you with tips on pregnancy, birth and looking after a new baby.
The midwives will ensure you are confident/competent during your stay on the post-natal ward.
There is lots of help available after you leave hospital; the hospital will connect you with your local Maternal and Child Health Nurse who will visit you at home and have regular appointments with you
You will be connected with a local Mother’s Group, a group of mums in your area who have also recently had a baby, the Mother’s Group will often also organise sessions on caring for a newborn
There are many websites and books to read to help with how to care for a new baby.
Yes, having a baby can be undignified, but your obstetrician and the midwives looking after you will do their best to maintain some sense of decency.
You can choose to wear your own comfortable clothing or many women choose to birth in a hospital gown that is long enough to cover them yet is easily removed if required.
Your dignity will return very soon after delivery and you won’t think too much about it.
Attending antenatal classes can help with education about what to expect when you go into labour. Unfortunately we can’t always tell when labour is about to begin or how long it will take. This loss of control can be very difficult for some women, but remember to talk about it with your obstetrician.
The best test of your ability to give birth is to have a go. There may be situations where you are advised otherwise by your obstetrician or midwife but in most cases the female body is amazing and somehow it all works out, even if you don’t think you can manage.
Your Obstetrician and midwife will be there to help you through the actual delivery process so don’t worry; you won’t be on your own.
Remember many babies are born by Caesarean Section so it is not your fault if you need a Caesarean Section, it will be the best decision for the future health of you and/or your baby.
Unfortunately most women having their first baby will need stitches of some sort, whether that is an episiotomy or tear. This is usually repaired under either local or regional anaesthesia and don’t worry, this area heals very well. By the time you reach your post-natal visit it is often difficult to even see where the stitches were. In most cases the stitches will be absorbable and won’t need to be taken out.
Your midwife will provide tips on how to care for any stitches.
Ice on the area helps enormously with pain relief and salt baths once you go home can be soothing.
This is very common in the first few months following childbirth but does improve with time. Take things slowly and gently when you first resume sexual activity, and perhaps use a lubricant. Talk to your obstetrician if you have ongoing problems as there are many things which can be done to help.
If you think you may be in labour earlier than your due date, don’t hesitate to call the delivery suite at St Vincent’s Private or your obstetrician. They will help you to work out what you should do and where you should go. In particular you should report vaginal bleeding or loss of fluid, or significant pain which does not settle.
St Vincent’s Private Hospital has a Level 5 Special Care Nursery which can care for babies over 32 weeks gestation.
They are the only private hospital in Victoria to provide CPAP to premature babies.
Some women may be required to be admitted to hospital for bed rest, this is not common, your obstetrician will discuss this with you, should your pregnancy require higher monitoring. Not all women on bed rest have premature babies.
Babies born at earlier gestations may need to be delivered or cared for in specialised units with neonatal intensive care units. These units have amazing survival rates for babies born at very early gestations. In some situations, labour can be suppressed, buying time for baby to gain maturity. In other situations you and your baby may be transferred to one of these specialised units.
There are many ways that your birth support team can help you through the birth of your baby. Whatever your fears happen to be, ensure you ask questions and be as informed as possible.
Thank you to obstetrician Dr Meredith Tassone for providing this post.
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Dr Hayden Waterham loves his job!
As a specialist obstetrician and gynaecologist Hayden thinks it’s a great privilege to deliver the highest possible level of care to women and their families.
He is aware that many issues related to conception, pregnancy, labour and delivery can carry every emotion. Unbridled joy, excitement, fulfillment and sometimes fear, anxiety and disappointment. Each pregnancy is unique and the greatest benefit of private care with Hayden is establishing a relationship that allows him to tailor his care to your individual needs.
Hayden can also help with problems related to heavy and painful periods, endometriosis, miscarriage and ectopic pregnancy, ovarian cysts and fibroids.
Hayden is completing a post fellowship qualification in ultrasound at the Royal Womens Hospital and works as a consultant obstetrician at Mercy hospital for Women where he helps train the next generation of obstetricians and gynaecologists.
Hayden sometimes comes to work for some rest! He is married to Dr Michelle Waterham and is regularly bossed around by his daughters and identical twin sons. Home life gives him perspective, humility, builds his resilience and stamina and is his greatest joy.
Contact Dr Hayden Waterham:
St Vincent’s Private Hospital Melbourne
Suite 5, Level 1
59 Victoria Parade, Fitzroy, 3065
Call the rooms: 03 9416 4566
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Dr Briohny Hutchinson is an obstetrician who is passionate about providing exceptional patient centered care. Paramount to this is her dedication and caring nature that is fundamental to the individualised care provided to each of her patients.
The opportunity to share a couple’s journey though pregnancy and delivery is incredibly special. Briohny places great importance on understanding her patient’s wishes while expertly guiding them to make informed choices and achieve a safe and healthy delivery.
With her broad range of Obstetric experience obtained both in Australia and overseas, Briohny is able to provide high level care for both uncomplicated and high risk pregnancies.
Briohny graduated with honours from Monash University in 2004. She commenced specialty training in 2007, undertaking training at the Mercy Hospital for Women as well as Geelong Hospital and The Northern Hospital. Upon completing her general training, Briohny travelled to Canada in 2012 to undertake a fellowship in Perinatology (Maternal Fetal Medicine) at the Lois Hole Hospital for Women, Edmonton.
After returning to Melbourne, she completed an additional 2 years of training in Maternal Fetal Medicine at the Mercy Hospital for Women. Here she gained further experience in obstetric ultrasound and high risk pregnancy management.
Briohny provides obstetric care to patients at St Vincent’s Private Hospital.
Outside the practice, Briohny is the mother of two beautiful young children and enjoys spending time with her family, baking and running marathons.
You can contact Dr Briohny Hutchinson at:
Melbourne City Obstetrics
Suite 5, Level 5, 55 Victoria Parade,
Fitzroy VIC 3065
E: admin@mcoga.com.au
P: 03 9415 6077
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Dr Marcia Bonazzi (MBBS FRANZCOG) is highly experienced women’s Obstetrician and Gynaecologist.
As a female ,Obstetrician and Gynaecologist, Dr Bonazzi focuses the majority of her time on Obstetrics and Gynaecology concerning the health and wellbeing of expectant mothers and their unborn child.
In addition to obstetrics, Dr Bonazzi’s interests include menopausal medicine, general gynaecological surgery (including laparoscopic surgery), colposcopy, abnormal pap smear and Mona Lisa Touch.
She has recently opened new rooms at level 1, 143 Victoria Parade Fitzroy, Melbourne, Australia in order to continue giving care and advice to women and their families in the areas on Obstetrics and Gynaecology.
Dr Bonazzi has a public appointment as Consultant Obstetrician and Gynaecologist at the Royal Women’s Hospital.
Dr Marcia Bonazzi gained her FRANZCOG in 2003, having spent time training in Italy and Brazil as a Specialist Women’s Obstetrician and Gynaecologist and is currently a member of the Australian Gynaecological Endoscopy Society (AGES) and the Australian Menopause Society.
Dr Bonazzi, alongside her efficient and experienced staff, is highly regarded by her patients for the care she provides and her warmth in communication.
She is fluent in English, Italian, Portuguese and Spanish.
Dr. Marcia Bonazzi
Level 1/143 Victoria Parade
Fitzroy VIC 3065
E: info@drmarciabonazzi.com.au
P: (03) 9419 5601
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Dr Amber Moore is an obstetrician and gynaecologist in full time private practice. She consults at St Vincent’s Private Hospital and the Epworth Freemasons Hospital in Melbourne. She is a consultant gynaecologist at the Royal Womens Hospital.
Dr Moore completed a Bachelor of Medicine and Bachelor of Surgery at the University of Melbourne in 1991. She was awarded her Fellowship of the Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG) in 2000. She also completed a law degree with honours at the University of Melbourne in 2002.
Dr Amber Moore provides the full spectrum of obstetric and gynaecological consulting and surgical services, with a particular interest in obstetric care and laparoscopic gynaecological surgery.
Dr Moore believes that treating patients is also about caring for families. She places great importance in valuing and caring for each individual patient, including assisting them to make informed choices concerning their treatment, and providing as much personal and face-to-face attention as possible.
Dr Amber Moore
MBBS FRANZCOG LLB (Hons)
Obstetrician, Gynaecologist and Laparoscopic Surgeon
Level 1, 59 Victoria Parade
Fitzroy Victoria 3065
Telephone (03) 9417 1156
Facsimile (03) 9417 4436
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Some infectious diseases can cause serious harm to pregnant women or their unborn babies. Ideally, women should be up to date with their immunisations before they become pregnant because it can protect a pregnant woman and her unborn baby from infectious diseases.
Obstetrician-gynaecologist, Dr Fiona Cowell, shares the types of vaccinations you should get when considering to conceive.
Most of us have been vaccinated as children and teenagers but for those who are thinking of pregnancy it is important to check that vaccinations are up to date. If vaccinations were missed as a child it is important to see your GP who can help you create a plan to catch up prior to pregnancy.
Varicella (chicken pox), rubella and measles immunisation status is something that your GP can check with a blood test. Even if you have been vaccinated in the past, your immunity can drop below protective levels. Catching these illnesses in pregnancy can have a big impact on both yourself and the baby.
Whooping cough (Pertussis) can be fatal for newborn babies. Boostrix vaccination is for pertussis, tetanus and diphtheria. This vaccination is given in pregnancy after 28 weeks gestation and can provide some protection to your baby when it is born until the baby receives its own vaccinations commencing at 2 months of age. Ensuring family members and partners are vaccinated before the baby is born is another important way to reduce the risk to the baby. A vaccination within the last 5 years will still be effective.
Influenza vaccination each year is a good idea for most people but especially for those who are pregnant. Catching the flu in pregnancy can lead to miscarriage and stillbirth. Women who contract influenza in pregnancy can be sicker than those who aren’t pregnant and each year pregnant women are admitted to ICU units with influenza. A vaccine can reduce this risk.
Dr Fiona Cowell is an experienced Obstetrician and Gynaecologist who works at MCOGA, a female group practice associated with St Vincent’s Private Fitzroy.
Location: Suite 5 Level 5 55 Victoria Parade Fitzroy 3065
Ph. 94156077
Web: www.mcoga.com.au
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So, you’re thinking about having a baby? Maybe in the near future or maybe in a few years? Maybe you’re already trying or are struggling to conceive? You’ve probably already had lots of unsolicited but well-meaning advice from friends and family but please go no further and read on. Hopefully I can set you on course!
For most women starting with a period and ovulation tracking app is a great idea. As a consequence you are becoming more aware of your cycle and your “fertile window”. Contrary to popular belief, your fertile window is in the days leading up to ovulation and more sex is not necessarily better. Generally intercourse is best every second day because increased frequency can lower the sperm concentration. Ovulation prediction tests can help but temperature monitoring is of no benefit as the temperature rise occurs after the event.
Our age of course is something of which we are constantly reminded. Sometimes women don’t have a choice about when they meet that Mr Right or career breaks may not be possible. But the unfortunate fact is that age is the biggest predictor of fertility particularly after 35 years where fertility starts to drop off quite dramatically. The chances of fetal abnormalities and miscarriages also rise. There are potential ways to improve fertility despite age so a discussion with your doctor or specialist is always worthwhile and please don’t wait more than 6 months if things just aren’t happening. Egg storage is now an incredibly viable option to consider for younger women who wish to preserve their fertility into the future.
There are however many other factors that affect fertility and reproductive health.
Did you know that your state of health around the time of conception can alter not only the chance of conception but also the genetic makeup of your egg and therefore embryo (i.e. baby)? This could mean lifelong health consequences to your child. This is the science of epigenetics. So, what can we do about this?
For a start quit smoking if you smoke before conception (and that goes for you too boys) and minimise your drinking. Both contribute to a reduction in fertility. Smoking in particular is also highly associated with miscarriage.
Whilst it’s always uncomfortable to talk about our weight it is an increasingly common cause of infertility in our modern world. It’s never meant to shame you; it is done out of concern for your health. Women who have a BMI over 25 have a 50% increased chance of not ovulating properly and this is increased to a 300% if your BMI is over 30. Being overweight also increases the risk of pregnancy complications such as diabetes and pregnancy loss. The good news is that even if you can lose 5% of your body weight you can increase your chances of conception significantly.
The food we eat should varied and wholesome and locally sourced. Ideally free from chemicals and not cooked in plastics. All women planning a pregnancy should be taking a folate containing preconception or pregnancy multivitamin.
It is ideal for women to be seen by a doctor before planning a child to check their general health, ensure they are up to date with vaccinations and cervical smears. Your family doctor is usually your first point of contact but an obstetrician is not only a specialist for your pregnancy but one who is happy to see you anytime during the planning stage. We are particularly keen to see you if you have any significant medical conditions or are having difficulties conceiving.
For more information go to www.yourfertility.org.au
Dr Miranda Robinson is an experienced Obstetrician and Gynaecologist who works at MCOGA, a female group practice associated with St Vincent’s Private Fitzroy.
Location: Suite 5 Level 5 55 Victoria Parade Fitzroy 3065
Ph. 94156077
Web: www.mcoga.com.au
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Most women know that a normal symptom of early pregnancy is nausea and occasional vomiting. There is nothing unusual about this and mild cases are annoying, but not a cause for concern. Sometimes the condition is severe and requires medical help to avoid dehydration and help you function in your day to day life, your morning sickness will usually improve around 12 to 15 weeks’ gestation.
Between 5-7 weeks nausea will commence. Vomiting once a day is common. While most women in early pregnancy feel better as the day wears on, some experience nausea and even vomiting all day. When symptoms are this severe, we call it “Hyperemesis Gravidarum”
Definitely not. Some ladies are fortunate and experience no nausea at all, and have completely healthy pregnancies. Likewise having morning sickness does not always mean all is well, and occasionally miscarriage (early pregnancy loss) can occur still despite symptoms.
With common milder cases the answer is no. Nausea can be very tiring and make concentration on day to day tasks difficult. Fortunately, medication is safe and available to help with this.
Yes. The first is dehydration. With severe cases, if you are vomiting several times a day, and unable to tolerate fluids you will become dehydrated. This can be easily treated by short admissions to hospital for intravenous rehydration, and safe anti-nauseant medication. Some hospital stays will be for a few hours at a time only, others for a day or two.
Occasionally when the condition goes on for a month or two, depression can occur. Like any chronic illness where a person cannot go about their normal day, morning sickness, particularly when severe can really wear you down. If you are feeling low due to these symptoms please feel free to discuss how we might improve the situation.
Typically, rich fatty food, pastries, and meat will not be easy to digest in early pregnancy. Dairy may also not be well tolerated. Often you will crave simple carbohydrates such as bread, crackers, rice etc. Nuts and dried fruit and raw vegetables are other options. Women have a heightened sense of smell when pregnant so cooking certain foods esp. meat will often bring on nausea and or vomiting. Individuals will have specific cravings which is not unusual.
Try to keep the fluid intake up; water, flat lemonade or ginger ale sipped regularly can be tolerated, electrolyte solutions are handy for salt replacement as well as a little sugar. Avoiding dehydration helps limit how bad you feel.
Yes. There has been for many decades safe and effective anti-nauseants for use in pregnancy. The most common ones are metoclopramide (often known as Maxolon or Pramin) and ondansetron (known as Zofran or Ondaz commonly). Taking doxylamine (a calmative muscle relaxant with anti-nauseant property is helpful at night if sleep is poor. Yes, hard to believe but morning sickness can be all day sickness if you are unlucky!
Very resistant cases can require additional medication if first line treatments don’t work well. Appropriate treatment till the condition resolves can stop vomiting and allow women to go to work, look after their families, feel happier, and keep reasonable dietary intake down.
Most women will feel better and normal by 15-16 weeks. The lethargy and nausea lift and they start to really enjoy the pregnancy. Up to 5% of cases will persist for longer, on occasion for the entire pregnancy. Careful support at home and work, and temporary lifestyle modification will help.
Thank you to Dr Peter England for providing content for this post.
Read more about Dr England on his website, or follow him on Facebook and Instagram
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Your pregnancy is a highly personal experience and requires individualised care, specific to your own health and lifestyle needs.
Dr Peter England is dedicated to providing bespoke and compassionate care to every patient to ensure they have the best pregnancy possible. Peter has worked in both Australia and the UK. He worked within the Diabetes Clinic at Royal Woman’s Hospital for 19 years and as head of the clinic for five of those years. During this time, Dr Peter England became well known for his expertise in managing highly complex and difficult pregnancies.
Private GP Shared Care Maternity Program
In his private practice, Dr Peter England, provides maternity patients with a boutique shared care program. The Private GP Shared Care Program allows patients the option of sharing their maternity care with a private, highly experienced obstetrician and their own personal GP. Any patient interested in discussing the Private GP Shared Care maternity program can call the rooms to discuss if the option is suitable for their maternity care on 03 94159088.
Gynaecology
Peter sees patients for general and surgical gynaecology appointments and has a particular interest in menstrual disorders and menopause.
Peter conducts many procedures via laparoscopic surgery, including removal of ovarian cysts, tubal ligation, hysterectomies, fibroid removal and treatment of endometriosis.
Public Hospital Appointments
Peter continues working as a Consultant Obstetrician at Royal Women’s Hospital (RWH). At RWH, Peter currently supervises and teaches obstetricians in training, both in the birthing suite and surgical technique in the operating theatre.
For patients requiring urgent care, last minute appointments are available and patients or doctors should call directly on 03 9415 9088.
Connect with Dr Peter England:
Visit the website for more information about pregnancy, birth and women’s health.
You can follow Dr Peter England on Facebook and Instagram.
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Birth announcements almost always mention a baby’s birthweight – it forms a considerable point of interest for parents, family and friends alike. Beyond this social curiosity, birthweight is an important health measure, as very small or very large babies may need additional care. A significant component of pregnancy care is aimed at identifying babies who are ‘small for gestational age’.
A small for gestational age (SGA) baby is generally considered to be one whose weight is less than the 10th centile (i.e. in the lowest 10% of the normal range of weight). This may be identified at birth using the birthweight, but can also be picked up during pregnancy using an ultrasound to calculate the ‘estimated fetal weight’ (EFW). This estimate is compared to the estimates for many other babies at the same gestation to determine where the baby’s weight falls in this range.
Just as healthy adults demonstrate a wide range of weights, so too do babies. Statistically, we expect around 10% of babies to be less than the 10th centile. Many of these babies are simply destined genetically to be on the smaller side (‘constitutionally small’) but are otherwise completely healthy. From a maternity care perspective, our interest lies in identifying those babies who are smaller than they ‘should’ be, for some reason. These are babies who are at greater risk of problems before and after birth, because they have not met their ‘genetic growth potential’, and are thus considered to be ‘growth-restricted’.
The smaller a baby is, the more likely it is to be ‘growth-restricted’ rather than ‘constitutionally small’.
There are many ‘pathological’ reasons for a baby being smaller than it should be. The most common being placental insufficiency, where the placenta does not work as well as it should. This is more common in mothers with pre-existing medical conditions such as high blood pressure or lupus, but is also seen more frequently in twin pregnancies, or can result from the use of certain medications or tobacco smoking. Other causes include infections (such as cytomegalovirus or CMV) and genetic syndromes. Most of the time, a baby is small for reasons out of their mother’s control.
This is easy once a baby is born, but a bit harder beforehand! In women with singleton pregnancies, after 24 weeks, the distance from the top of the uterus to the pubic bone (the ‘symphysio-fundal height’) in centimetres roughly approximates the gestational age in weeks. If this measurement is smaller than expected or doesn’t increase appropriately as the weeks pass, it may be a sign of an SGA baby. In these circumstances, an ultrasound is advisable to determine the estimated fetal weight. Ultrasounds are also suggested to women for whom measurements of the symphysio-fundal height are likely to be inaccurate, such as larger women, those with twins or uterine fibroids.
When an ultrasound is performed, key measurements are taken to help estimate the baby’s weight. These generally include the length of the femur (thigh bone), the abdominal circumference, the head circumference, and the biparietal diameter (distance across the skull). These measurements are combined into a formula that produces an estimate of the baby’s weight. And it is just that – an estimate, with a margin for error of at least 10%. That said, ultrasound is the most accurate means available to determine a baby’s size, and given that it is safe and readily available, it remains the standard of care in identifying a small baby.
If your baby is identified on ultrasound to be small for gestational age, your maternity care provider will discuss with you the potential causes relevant to your circumstances, and outline additional investigations that could be performed to determine the underlying cause. After that, depending on your gestation, regular ultrasounds are arranged to observe the baby’s ongoing growth and assess its wellbeing. Results of these tests will help your care provider give you information to determine the best way and time to have your baby. With monitoring, many small babies may safely be carried to term or near-term, but some will do better if they are born earlier.
Baby doctors (neonatal paediatricians) commonly attend the births of babies who are expected to be small, to provide additional support with breathing should it be required. Small babies may need to be admitted to the neonatal nursery for additional care with temperature regulation and feeding, but many can ‘room in’ with their mothers. How long your baby will have to spend in the hospital will depend on many factors, but primarily the size and gestation at birth.
It is generally recommended that the placenta from SGA pregnancies be sent to the laboratory for analysis, which may identify specific reasons for the baby’s smallness.
If your last baby was SGA, it is a good idea to seek obstetric care before a further pregnancy, so that the results of tests performed in the previous pregnancy can be reviewed and a plan developed for the next one. As with many conditions in medicine, having had a previous SGA baby does increase the chance of having another one, although this risk varies depending on the cause of the SGA. There is some evidence to suggest that low dose aspirin from the first trimester can reduce the recurrence of placental insufficiency. Close monitoring of your baby’s growth will be undertaken in future pregnancies, typically with several ultrasound scans.
Growth restricted babies (those who are smaller than they should be) are at increased risk of long term cardiovascular and metabolic disease, such as diabetes and obesity. These risks can be managed with clinical surveillance and attention to lifestyle factors. However, most babies who are born small go on to have healthy lives as children and adults.
Dr Stefan Kane has recently joined the SVPHM team and is a part of the Melbourne Maternal Fetal Medicine group (Melbourne MFM). In addition to providing care to women with uncomplicated pregnancies, Dr Kane has extensive experience in managing complex, high-risk pregnancies as a Maternal Fetal Medicine Sub Specialist.
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Inflammatory Bowel Disease (IBD) comprises of a group of conditions that cause inflammation of the digestive tract and includes Crohn’s disease and Ulcerative Colitis. IBD is most commonly diagnosed between the ages of 18-35. Hence, it follows that a majority of women will conceive for the first time after their diagnosis. Thankfully, with the winning combination of a dedicated IBD care team and an appropriate treatment plan, most women go on to have an uneventful pregnancy and deliver a healthy baby.
Most women with well-controlled IBD have normal fertility. However, fertility may be reduced in those who have had extensive bowel surgery to control their IBD due to pelvic scarring. Medications used to control IBD generally do not impair fertility. However, women on certain medications, such as Methotrexate, will be advised not to attempt pregnancy as it can be dangerous for the developing baby.
Male partners living with well-controlled IBD will also generally have normal fertility; however, some medications may lower sperm count. Extensive abdominal or pelvic surgery may also impair fertility in males.
Women with well-controlled IBD before conceiving and throughout pregnancy will generally achieve a healthy outcome. Women with active inflammation, described as ‘flares’, either immediately before pregnancy or in the first trimester of pregnancy are at higher risk of delivering prematurely or having a low birth weight infant.
Disease activity of IBD at the time of conception is the most significant predictor of disease activity throughout the pregnancy. That is, women who become pregnant when their disease is flaring are more likely to experience active disease throughout their pregnancy. Conversely, those in remission are likely to remain so for the rest of pregnancy.
It is also thought that women with Ulcerative Colitis are at slightly higher risk of active disease during pregnancy compared with Crohn’s Disease. IBD activity in one pregnancy does not necessarily predict disease development in a subsequent pregnancy.
Ideally, women with IBD should seek advice from their gastroenterologist and an obstetrician at least three to six months prior to conception. This allows for collaboration between the IBD care team and enough time to ensure that the IBD is well controlled on the correct medications before conception. A clear collaborative treatment plan for the remainder of the pregnancy and postpartum can be made during this time.
Most medications, with the exception of Methotrexate, are safe to continue in pregnancy. Current evidence does not suggest that medications used to manage IBD in pregnancy increase the risk of birth defects. Furthermore, stopping medications suddenly may lead to a flare of IBD, which places the pregnancy at risk of premature delivery. Prior to making changes to their medications in pregnancy, women should seek advice from both their gastroenterologist and their obstetrician.
Women with IBD will be seen by their obstetrician and gastroenterologist more frequently during pregnancy. Blood and stool tests will be performed at least monthly to monitor the level of IBD activity and to detect flares early. Medication doses may need to be changed to accommodate the changes of pregnancy. Along with routine obstetric care, women with IBD will have closer monitoring of fetal growth and wellbeing through ultrasound throughout the pregnancy.
The type of birth, vaginal versus caesarean section, will be a collaborative decision made between your obstetrician, gastroenterologist and yourself. In most circumstances, women with IBD can safely attempt vaginal birth, but a caesarean may be recommended in cases of previous surgery or where the risk of injury from a vaginal birth is thought to be too high.
If one parent has IBD, the chances of your child inheriting IBD remains low, around 3-8%.
Breastfeeding provides many benefits for the baby, including reducing the risk of conditions such as IBD. It is safe to breastfeed with most medications used to manage IBD in pregnancy.
Dr Iniyaval Thevathasan has recently joined the SVPHM team and is a part of the Melbourne Maternal Fetal Medicine group (Melbourne MFM). Dr Thevathasan is a maternal fetal medicine subspecialist obstetrician primarily based at St Vincent’s Private Hospital in Fitzroy. She understands what a privilege it is to provide care during pregnancy and delivery, and provides expert, inclusive, patient-centered care from pre-pregnancy through to the postpartum period to achieve a safe and healthy outcome.
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