Should pregnant women sleep on left lateral position?

It was long believed that pregnant women should lie on their left side. They thought it improved the feto placental circulation by reducing aorto-caval compression by gravid uterus.
But the truth was that this remained unproven. counter arguments can be:

• woman whose circulation is affected will feel uncomfortable and dizzy. She will spontaneously turn, without any instructions to do so.
• the circulatory effects were demonstrated in test conditions, like in anaesthesia, which may not be the case in normally sleeping woman
• if the sleeping position improved the pregnancy outcome, natural selection would have favoured laterally sleeping women, or at least those who turn to side in pregnancy.

But recently they have come up with a study which shows 2 fold rise in still birth in women lying in other than left lateral position.
the original article
All media highlightened this.

But the recommendation is still that, pregnant need not be adviced to lie in any particular position.

The above study is a retrospective poorly controlled study.
Suggested reading:

• NHS : Mother's sleeping position and risk of stillbirth
• bmj editorial
• Evidence from Danish national birth cohort

Published with Blogger-droid v1.7.4

Weight gain in Pregnancy

All pregnant ladies and their attendants are usually very anxious about her weight gain. A pregnancy lady gains about 10-12 kgs, only about one or two kgs in first 3 months, and rest of it after that.

None of the antenatal check up guidelines recommend regular check of female's weight (except at booking visit). Still it continues to be in the minds of our people, and is taught to ANMs and midwives.

Why we need not check the lady's weight routinely?

1. Though the woman gains weight naturally, any deviations in it, doesn't correlate well on the adverse pregnancy outcomes like pre-eclampsia, diabetes, macrosomia, or IUGR. 
2. We can better directly assess these pregnancy- deviations by clinical examination and ultrasound, than indirectly from the patient's weight gain. 
3. A normal weight gain may falsely reassure us that pregnancy is proceeding normally, where, actually it may not be. 
4. Abnormal weight gain in a normally proceeding pregnancy may cause unnecessary anxiety to the patient. 

links:
http://www.babycentre.co.uk/pregnancy/antenatalhealth/physicalhealth/weightgain/
(Mums-to-be used to be weighed every time they went for an antenatal check. Then doctors realised that this made many women anxious. It wasn't a useful way of assessing how well their pregnancies were going.)


Nice guidelines: http://www.nice.org.uk/nicemedia/pdf/CG6_ANC_NICEguideline.pdf

1.5.1.1 Maternal weight and height should be measured at the first
antenatal appointment, and the woman’s BMI calculated
(weight [kg]/height[m]2).
1.5.1.2 Repeated weighing during pregnancy should be confined to
circumstances where clinical management is likely to be
influenced. 

US guidelines:http://www.guideline.gov/content.aspx?id=14306

 Maternal weight and height should be measured at the first antenatal appointment, and the woman's body mass index calculated (weight [kg]/height[m]²).Repeated weighing during pregnancy should be confined to circumstances where clinical management is likely to be influenced.