Tuesday, January 28, 2014

How advanced in my pregnancy do I have to be before I can clearly hear the baby's heartbeat with a stethoscope?

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Jade Orchi


I can barely catch little snatches of it now at 12 weeks. How much longer before I can hear it clearly?
I have excellent hearing... It sounded like a muffled clock ticking at about two to three times my own heart rate. I have a Sprague double tube stethoscope from my CNA days and that's what I've been using.



Answer
There are many variables including the acuity of your own hearing, the type of stethoscope used and the location and position of the fetus.

Amplified electronic stethoscopes (which cost $30 to $60) usually state that for best results, 21 to 28 weeks of development are required. Typical audio stethoscopes might require about 4 additional weeks.

The heartbeat will usually run in the range of 120 to 180 beats per minute (2 to 3 per second) and if everything is in the best condition, hearing it at 12 weeks is not that unusual. Just do not freak out if the next time you try, you do not hear anything. If the baby turns, the distance between its heart and the stethoscope can double or triple and make listening very difficult.

Doppler monitors will be able to pick up the heartbeats sooner and more clearly than any stethoscope but can be expensive to rent.

If you are careful, you might hear the baby hiccup or even kick. Try not to get too excited as your regular heartbeat (at its regular rate) is one of the most soothing things for the baby. Relax as much as you can. Learn to breathe deeply.

How long does t3's with codeine stay in my system and breastmilk?




Elizabeth'


i gotta have some dentist work done, the dentist is going to give me some of these pills. how long does it stay in my body and my breastmilk?


Answer
Its relatively safe to take codeine while nursing. It was the drug of choice by now there is some concern because some moms have a genetic abnormality which causes them to turn more of the codeine into morphine

http://www.kellymom.com/health/meds/pain-meds.html
Info on selected medications used for pain relief
Name of medication

AAP approved?*
Pregnancy Risk Category**
Lactation Risk Category**

Notes
Acetaminophen
(Tylenol)
Approved
B
L1

Aspirin
Caution
C (1st, 2nd trim.)
D (3rd trim.)
L3

1
Azapropazone
(Rheumox)
Approved
- L2

Butalbital
(Fioricet, Fiorinal, Bancap, Two-dyne) NR D L3 2
Butorphanol
(Stadol)
Approved
B (1st, 2nd trim.)
D (3rd trim.)
L3


Celecoxib
(Celebrex) (FDA safety info) NR C L2
Codeine
(in Tylenol #3, #4)
Approved
C
L3

3 [# Hale suggests weakened or premature infants be observed for sedation and apnea.]

http://toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/~Z8Qmpm:1
Summary of Use during Lactation:
Maternal use of maximum dosages of oral narcotics while breastfeeding can cause infant drowsiness. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics, particularly in the first week of life. However, the newborn's dosage is limited by the small volumes of colostrum in the first 2 to 3 days postpartum. Once the mother's milk comes in, it is best to limit the maternal dosage and duration of treatment with codeine (and combinations) and to supplement analgesia with a nonnarcotic analgesic if necessary. Maternal dosages as low as 0.63 mg/kg (about 40 mg) daily have caused infant drowsiness in a breastfed infant and daily maternal dosages of 1.6 mg/kg (about 100 mg) are likely to cause drowsiness in many breastfed infants. Mothers who are have ultrarapid CYP2D6 metabolism may excrete unexpectedly large amounts of morphine into their milk after codeine use and increase the risk of adverse infant effects lower dosages. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.[1]

[...]

Effects in Breastfed Infants:
Codeine has been reported to be the possible cause of asymptomatic bradycardia 6 days following a 30 mg single maternal codeine dose in a week-old, term, exclusively breastfed infant.[11]

Four probable cases of apnea associated with maternal codeine intake of 60 mg every 4 to 6 hours were reported in 4- to 6-day-old term and near-term breastfed infants. Apnea resolved 24 to 48 hours after withholding breast feeding and discontinuation of maternal codeine.[12]

In a case-control study of 12 breastfed term newborns with unexplained episodes of apnea, bradycardia or cyanosis during the first week of life, maternal oral codeine use was determined to be the probable cause. A higher proportion of newborns with episodes, 83 vs 31%, had mothers using opiates, including codeine, for postpartum analgesia. The mean number of doses taken was also higher with mothers of case newborns taking a mean of 10 doses (range 4 to 22) vs. 5 doses (range 1 to 13) in the control group. There were no differences in other perinatal and demographic factors between cases and controls.[13] The authors recommended discontinuation of breastfeeding if infants of mothers taking opiate analgesics have unexplained negative cardiorespiratory symptoms.

No apnea, bradycardia, or color changes occurred in 11 healthy, term, 1- to 3-day-old newborn breastfed infants exposed to codeine in milk. Their mothers had taken an average of 4 doses of oral codeine 60 mg every 4 to 6 hours prior to breastfeeding.[8]

In one telephone follow-up study, 19% (5 of 26) of breastfeeding mothers taking multiple doses of codeine reported drowsiness in their infants. All infants were younger than 1 month.[14] The authors added that the elimination half-life of codeine's metabolite, morphine, is prolonged in the newborn period which may explain why the adverse reaction was reported in only infants younger than 1 month.

A large case-control study of 504 children with neuroblastoma found a statistically significant 2.4-fold association of the disease with maternal use of opioid agonists during pregnancy and lactation. This finding was largely attributable to a 3.4-fold association with maternal codeine use. Opioid exposure during lactation had a 3.5-fold association while codeine exposure had a 5.1-fold association. Because neuroblastoma is a sympathetic nervous system tumor arising from the progenitor cells of the sympathetic ganglia and adrenal medulla, and because codeine does cross the placenta and is transferred to milk, the authors of this study speculate that codeine's neuroendocrine effects could disrupt ad




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