Dr Nadia Samuel

Happy International Women’s Day!

Invest in Women, accelerate progress

Wishing you a day filled with inspiration. May you always be blessed, confident, and compassionate in all that you do.

A special thank you to all who messaged, liked, and sent love my way yesterday.

Happy that I can touch lives, make a difference to each of you and feel appreciated while doing so.

Here's to continuing to serve you. I appreciate you.

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What a milestone!
Today marks the 15th anniversary of my first day in office back home in St. Lucia after years and years of medical school in Trinidad and then specializing in the UK

On March 2nd 2009, the day that would have been my first day as a Consultant OBGYN in the UK, instead I bravely sat in this office for the first time.

There have been ups and downs, but not one day do I regret my decision to come back home!

Here's to 15 more years and improving women's health, delivering babies and everything else in between 🥂


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This is your chance to win a free THERMIVA treatment

DM your name and phone number for a chance to win

Draw takes place on 12/2/24 and treatment day is Valentine's Day

Good luck

It's that time of the year again!

What will we give away this year?
Stay tuned...

A lot of women don't realize that they do not need to suffer during the perimenopause and that their periods need to stop before they can get treatment.
Effective treatment is available during the perimenopause, schedule your visit to discuss further.

Limiting alcohol, exercising regularly, eating a healthy diet and managing stress can also help reduce the burden of symptoms.

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The perimenopause is the presence of menopausal symptoms in women who still have a period.

The menopause is when the period has been absent for more than 12 months.

The postmenopause is the time after the menopause when a woman may not have symptoms but remains at risk from low estrogen levels.

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Helpful tips

Please arrive 10 minutes before your scheduled appointment.

The office will contact you if there is an unreasonable waiting time.

Please cancel or reschedule your appointment in a timely manner (at least 24 hours prior, not 5 minutes before 🙃)so that another patient can get that appointment slot.

Please walk with an insurance form, or know the name of your insurance company so that we can provide you with one.

It is not mandatory that someone attends your appointment with you, but you are welcome to do so if that is more comfortable for you. Please ensure that this person can be privy to your private medical information.



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What to expect from your visit

Whether your first or return visit, you will be given the opportunity to express your concerns and this is a good opportunity to refer the list your prepared.

An in depth review of your periods will be conducted. As well as some frankly embarrassing questions about your menstrual and sexual health, contraceptive need or preparing for pregnancy as needed.

Menopause symptoms and coping will be discussed with the relevant age group.

Your examination will include a pelvic examination, Pap smear, STI screening and pelvic ultrasound scan as needed.


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Helpful information to maximize your visit with Dr Samuel

-don't book your appointment if you are on your period.

-write down a list of all your concerns that need to be addressed.

-bring your period tracker/menstrual calendar (Flo or Period tracker are 2 great apps).

-know the FIRST day of your last period (we really don't need to know when it ended).

-bring in copies of previous tests done if relevant.

-know your medical surgical and family history

-avoid in*******se for the 24 hour period before your appointment.

-there is no need for "grooming" (waxing or shaving)



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Zika virus infection in pregnancy

Zika virus infection is from a mosquito bite, in pregnancy, infection with Zika can result in microcephaly in the newborn.

Other infections that can be dangerous to the fetus during pregnancy include:
-Listeria infection -from undercooked foods such as deli meats and soft cheeses
-Toxoplasmosis- from raw meat or cat waste

Especially during pregnancy
-wash your hands often
-avoid sharing food, drinks and eating utensils with others
-avoid mosquito bites
-avoid cleaning your cat’s litter box



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X-rays in pregnancy

X-rays are sometimes needed during pregnancy and breastfeeding

Most women will be concerned about potential radiation exposure of the fetus from these studies, but, if the medical reason for the x-ray outweighs any potential risk to the fetus, this should be done.

The same goes for dental X-rays, the radiation exposure to the fetus is tiny and is not considered harmful.

Lead apron shielding is no longer recommended to protect the fetus.

Do not delay your medical or dental care during pregnancy




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Weight gain in pregnancy

The recommended weight gain in pregnancy varies from one woman to the next and is based on prepregnancy BMI
See information on 2nd slide ➡️

Excessive Weight Gain in pregnancy can lead to complications such as
-having a large baby
-need for caesarean section
-preeclampsia
-gestational diabetes

Inadequate weight gain can cause baby to be too small, especially in underweight women




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Vaginal ultrasound scan

Also called an internal, transva**nal or endova**nal scan.

This is an ultrasound scan done using a transducer/ probe that is inserted into the va**na. This gives clearer images of the pelvic organs than an abdominal scan. In pregnancy, it is especially important in the early diagnosis of ectopic pregnancies, confirm viability in early pregnancy, better visualization in obese patients in early pregnancy. Later on on pregnancy, it is used to monitor the length of the cervix to predict preterm labor, and for accurate placental location

The transva**nal ultrasound scan is not painful nor does it cause a miscarriage.


**nalscan

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T is for tears, va**nal or perineal tears.

Tears sustained during delivery are classified by degrees, from first to fourth, according to the extent of the tearing. See the infographic for more information.

What are the risk factors for tears?
-having your first baby
-a previous tear
-having a big baby
-having a ventouse or forceps delivery
-shoulder dystocia

Can you reduce your risks of tearing?
Yes
-perineal massage from 36 weeks to prepare for delivery
-pelvic floor exercises
-listening carefully to the instructions of your birth attendant for a slow controlled delivery of the head.

**naldelivery
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Swelling in pregnancy

Most pregnant women (up to 75%) experience swelling of their feet, and sometimes in their hands where rings may become tight.
Swelling is usually better after resting.
This is NORMAL in pregnancy and is not a danger to the mother or baby.

The swelling is due to
-increased blood volume in pregnancy
-the weight of the uterus preventing return of blood from your legs to your heart
-hormonal changes affecting blood vessels

How to limit swelling?
-avoid standing for too long
-elevate your feet as much as possible
-limit intake of salty foods
-hydrate adequately
-sleep/rest on your left side
-exercise ( walking, swimming, yoga or Pilates) keeps blood circulation going
-compression stockings can help
-massage
-wear comfortable shoes

Swelling that is associated with preeclampsia can be differentiated from normal swelling by
-not resolving with rest
-swelling involves the face and hands
-sudden increase in the amount of swelling



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The Rhesus factor (Rh)

Rh is a protein found on red blood cells, Rh negative means you do not have this protein. Most people are Rh positive.

If you are Rh negative from your blood tests done during pregnancy, the blood group of your partner would need to be determined. If he is positive, it will be assumed that the baby is positive as well.
Anti-D will be administered during pregnancy and at delivery when baby's Rh factor is determined.

Usually, during pregnancy, your blood does not mix with your baby's blood. But sometimes it does, especially right after the baby is born. If a small amount of the baby's blood gets into your blood vessels during delivery, your immune (infection-fighting) system makes proteins called "antibodies"(Sensitization).Then, if you get pregnant again in the future, these antibodies can cross the placenta and damage some of the next baby's red blood cells. This can cause a condition called anemia, which is when a person has too few red blood cells. If this happens, the baby can make more red blood cells, but sometimes not enough to prevent anemia. Anti-D prevents this "sensitization" from happening.

-D
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Quickening

When you first feel your baby move, it may feel like a gentle flutter in your belly or like gas bubbles.
These first movements are called Quickening.

First time moms usually feel this between 18-20 weeks, experienced moms usually feel these sooner, by 16-18 weeks.

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Postpartum Hemorrhage (PPH)

This refers to the loss of an excessive amount of blood at delivery, whether a va**nal delivery or caesarean section.

This may be caused by the failure of the uterus to contract after delivery, or from tears, retained placental tissue or clotting disorders.

Risk factors include
-previous PPH
-big baby
-prolonged labor
-polyhydramnios (excess amniotic fluid)
-multiple pregnancy
-fibroids
-placenta previa
-placental abruption

After recognition of excessive bleeding, either by measurement or the patient becoming faint and dizzy, the first step is to rub up a contraction of the uterus followed by medication to contract the uterus.
This may necessitate going into surgery to repair tears/trauma, remove retained products, insertion of a balloon tamponade catheter or hysterectomy if nothing else works.



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Obesity in pregnancy

Having a BMI over 30 does increase your risk of complications in pregnancy such as
-gestational diabetes
-hypertensive disorders of pregnancy
-macrosomic (large) baby
-caesarean section delivery

Weight loss prior to and in between pregnancies can lower these risks, as can limiting the amount of weight gain in the current pregnancy.




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Nosebleeds in pregnancy

Another common problem, but nothing to worry about.

Hormonal changes of pregnancy puts women at risk, including increased blood flow to the nose, increased congestion and stuffiness and increased blood volume which can rupture the small blood vessels in the nose causing the bleeding.

If you do get a nosebleed
-sit up and lean forward
-pinch your nose firmly just below the bony part (nose bridge)
-keep steady pinch for 10 minutes
-the bleeding should stop within this time

Do not
-tilt your head backwards
-lie down
-stick anything up your nose



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Membrane Sweep/Stretch &Sweep/ Membrane stripping

This is a simple procedure done during a routine antenatal check-up where the membranes of the sac around your baby are pulled away from the wall of the uterus.
A finger is inserted into the internal cervical os and rotated around. (The cervix has to be partially dilated for this to be successfully done)

This procedure releases prostaglandins which prepare your body for labor.

Having a membrane sweep and reduce the need for induction of labor and increases the rate of spontaneous onset of labor, usually within 2 days.

Did you get a membrane sweep?



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Leg cramps in pregnancy

These are very common, as many as 30% of pregnant women experience these.
Most commonly in the calf muscles and at night.

Ensure you stay hydrated, stretch before bed, avoid stretching your legs with your toes pointed. Magnesium and calcium supplements may help.

To ease the cramp, pull your toes up toward the ankle, rub the muscle or apply a heating pad.



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Although there is no robust evidence that kick count monitoring has a major impact on preventing adverse outcomes, it is a useful tool for expectant moms to pay close attention to fetal movements

Advised after 28 weeks
The “count to 10” method refers to the perception of at least 10 movements in a 2 hour period.
Actions that can encourage fetal movements include changing position, having a glass of cold water or a snack, being active, or gentle prodding of the abdomen.

If baby doesn’t respond and fetal movements are decreased, contact your health care provider or attend the maternity unit for assessment.

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A common question posed is when to announce your pregnancy, and more specifically, when to inform your workplace.

We usually recommend that pregnancy announcements be made after the danger period of 12 weeks have passed.

There is no perfect time to inform your job, but please do this before the pregnancy becomes obvious. Ensure that your boss is the first in the workplace to know to avoid gossip reaching them.
Follow up your announcement with your maternity leave certificate and make solid plans for your maternity leave dates.
In St.Lucia, the maternity leave entitlement is currently 3 months, where NIC pays 65% of your earnings during this time. There is also a maternity grant payment at delivery


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Induction of labor refers to starting labor with use of medication. The most common reason is for prolonged pregnancy over 41 weeks.
Other reasons may exist if the risks of continuing pregnancy exceed the risks of inducing labor and include gestational diabetes, growth restriction, premature rupture of membranes, cholestasis of pregnancy and hypertensive disorders of pregnancy.

Labor may be induced with prostaglandins, catheter, amniotomy or oxytocin.

Risks of induction include feral distress, failed induction, caesarean section, uterine rupture and postpartum bleeding.


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Nausea and vomiting is a common pregnancy symptom which usually starts between week 4-7, and settles by 12-14 weeks.

It affects most pregnant women to some degree, it is usually called morning sickness but symptoms can last all day.

You are more likely to have it if
- you’ve had it before or
- you have a multiple pregnancy (eg twins)

What is hyperemesis gravidarum?

If the nausea and vomiting becomes so severe that it leads to dehydration and significant weight loss, it becomes hyperemesis.

Pregnant women with hyperemesis may need to be admitted to hospital for treatment.


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Gestational diabetes

Affects 2-10% of pregnant women.
It is important to detect and manage during pregnancy to reduce the risks of complications to mom and baby such as
-having a large (macrosomic) baby with risks of injury to baby (shoulder dystocia) and mom (caesarean section, va**nal tears)
-stillbirth
-neonatal hypoglycemia (low blood sugar)
-preeclampsia

Women with gestational diabetes are at higher risk of developing Type 2 diabetes later in life.



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Fibroids in pregnancy

A very common finding because of the high incidence of uterine fibroids in our population

Fibroids do increase in size during pregnancy and most will decrease in size after pregnancy.

Some of the complications seen during pregnancy with fibroids include
- pain due to fibroids degeneration ( dying off of fibroids due to their rapid growth outgrowing the blood supply)
-miscarriage:- more commonly seen with Submucosal fibroids
-preterm labor and delivery
-placental abruption
-placenta previa
-malpresentation (breech or others(")
- need for delivery by Caesarean section



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Eclampsia

This refers to the new onset of seizures in a pregnant woman, usually with pre-existing severe preeclampsia.

Preeclampsia refers to high blood pressure in pregnancy along with protein in the urine, dysfunction of kidneys, liver, brain, placenta and eye.

Symptoms of preeclampsia include
-severe headaches
-changes in vision including blurring, flashing lights or floating spots
-pain in the upper abdomen
These are danger symptoms that should not be ignored.

Preeclampsia can be treated with medication to control the blood pressure, medication to prevent seizures but ultimately, delivery is needed.



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