Pregnancy is the result of an ovum in the female being fertilised by male sperm, and occurs at a certain time of the month.

Symptoms:

Absence of menstruation, nausea, vomiting, mild tenderness of the breasts. Sometimes, frequent passing of urine and urgency. In the later stages, perhaps 18 weeks, there may be movements of the uterus and, of course, weight gain.

Signs

There is engorgement of breasts - sometimes milky-discharge, enlargement of abdomen and mild irritation of neck of the womb occurs around the 7th week.
The neck of the womb becomes soft at the 7th week from the last date of menstruation (LMP).

The upper part of the uterus (fundus) can be felt just above the front of the pelvic bone (symphysis pubis) and at around 20-22 weeks, the uterus can be felt at the umbilicus (belly button).

The heart sounds of a baby can be heard at 12 weeks by a special instrument called a Doppler, and at 20 weeks the normal foetoscope.

Pregnancy Tests

All the urine tests depended on the detection of HCG (human chorionic gonadotrophine) produced by the placenta. The HCG levels increase immediately after the fertilised ovum imbeds in the uterus, and then double every 48 hours or so, reaching its highest level around 51-57 days of pregnancy.

If the HCG levels are low, then the chances may be that it is an ectopic pregnancy. Ectopic means any site other than the uterus e.g. peritoneum, fallopian tubes - but mainly tubes.

Some pregnancy test kits are very sensitive these days and are as good as laboratory tests.
If you have missed your periods and would like to test for pregnancy, these are available at any pharmacist. Whatever the result, you should go to your health care professional for further action.

There is a much to do in the early-mid and late care, and it is important that the professionals are involved as soon as possible.

Pre-Natal Care

Once you have confirmed the positive test recording, you must visit your health care professional as early as possible. The visit to the midwife, mainly consists of details of age, occupation, ethnic back ground, and the last menstrual period.

Provisional conception date is calculated, and medical history is obtained. A history of previous pregnancies will be taken into account, such as duration and complications. Details of alcohol intake, smoking, caffeine, nutrition and medication are noted, as is family history of any congenital abnormalities and any genetically transferable diseases.

Physical examination

The midwife will be your contact point throughout the pregnancy until the baby is born, and will record height, weight and blood pressure.

An examination will involve assessing height of uterus, and also checking the pelvic adequacy and the condition of the cervix for any infection, and its anatomical position e.g normally the cervix faces the front but in some cases it may be facing backwards (retroverted) which has significance if labour has to be induced by artificial membrane rupture after the due date. Foetal heart sounds can be detected by ultrasound around 6 weeks, and by doppler round 10-12 weeks.

Other Tests

Full blood count for detecting iron levels: in Asians thalassaemia trait, and in Afro-Caribbean women, for evidence of sickle-cell disease or anaemia and for presence of variants of haemoglobin.

All women above 35 years of age, are told about amniocentesis around 16 weeks of pregnancy, to detect any abnormality in the developing baby.

A test called Jay-Sachs blood screening should be offered to Jewish women with Jewish partners.
Women who work in medical, dental or public safety departments, should be offered hep-B antigen, and if at risk, should be vaccinated with hep-B injection.

Antenatal Appointment

The frequency of antenatal visits is as follows:

During the early stages to 28 weeks of pregnancy, if all is well as determined by tests and midwife examination, it is conducted at 4-6 week intervals; from 28 to 36 weeks every 2 weeks, and from 36 weeks every week until the baby is delivered.

Medications

Your health care professional should be told about any medications that you are taking including those bought over-the-counter.

Some of the drugs that can cause deformities in a developing baby are as follows:

·  Chloromycetim

·  Antibiotics (in the 1st trimester)

·  Alcohol

·  Aspirin, NSAIDs, salicylates (in 3rd trimester)

·  Diazepams

·  Anatbuse (used in alcoholism)

·  Ergot preps (used in migraine)

·  Lithium (antidepressant)

·  Griseofulvin (antifungal)

·  Radioiodines (anti-thyroid)

·  Sulfonamides (3rd trimester)

·  Tetracyclines (discolours babies teeth permanently)

·  Tobacco smoking (intra-uterine growth retardation to baby IUGR)

·  Warfarin (anticoagulants).

Alcohol and Smoking

There is no established safe level of alcohol, so abstinence is the rule here. Cigarettes not only can cause (IUGR), but also developmental problems and defects in the lungs of the baby. Stopping smoking (or at least cutting down) is the best course of action.

X-rays and Chemical Exposure

·  Avoid all x-rays and tell your doctor/dentist that you are pregnant

·  Avoid all chemical or irradiation hazards

·  It is advisable not to handle a cat litter as these contain harmful organisms

·  Wear gloves and avoid hot saunas and excessive hot water dips

Diet

·  Eat a balanced diet of fruit and fibre - drink plenty of clear fluids which are water based

·  Avoid caffeine and cola-containing drinks

·  Folic acid is good for foetal developments and avoiding neural defects in the baby. You can take either the 400 mcg tablet, or foods containing natural folic acid

·  You will have a weight again between 20-40 lbs. Expect this, and do not try to lose weight or diet

·  If your weight remains static, contact the midwife immediately

·  Do not eat raw or half-cooked meat

·  Always wash your hands after handling raw meat

·  Fresh fruit and vegetables should be washed thoroughly before eating. They contain chemical coatings to make them look attractive!

Rest

Rest is an essential requirement of pregnancy. Try to rest and relax as best as possible during the day, but continue with normal day-to-day activity. However, it is advisable not to do any strenuous physical activity e.g. lifting heavy weights. Gentle exercise is recommended - walking is good.

Birth Classes

These take place around 22 weeks and are designed for you and your partner. The classes teach gentle exercise and explain the purposes of the labour period.

Ante-Natal Clinic

During each visit, the following will be monitored by the midwife:

·  Record of weight gain

·  Blood pressure

·  Height of uterus

·  Heartbeat and urine examination for proteins and sugar ketones to detect whether you are moving towards pre-eclampsia (high blood pressure in pregnancy), diabetes of pregnancy or dehydration.

At 6-12 weeks, the size of the uterus is confirmed by internal examination, and request forms are given for blood to be taken to enable measurement of full blood count and status of anti D antigen.

Between 12-18 weeks, counselling is offered to women over the age of 35 if there is a family history of abnormalities in babies, or any chromosome abnormality or neural tube defect.

Amnioncentesis is offered for detection of any abnormality. There are some dangers in this procedure (which includes abortion) but modern techniques are becoming safer.

At 12 weeks, an ultrasound scan is performed, to see if the size of the baby corresponds to the calculated date of delivery. There may be a discrepancy in a number of cases with regard to predicting behaviour at full term date, so some flexibility should be allowed for. This procedure will also predict any abnormalities found in the baby, though if in doubt, referral for a specialised scan can be arranged. This is usually just to confirm any doubts and should not lead to unnecessary worry.

At 16-20 weeks a blood test called a serum alfa foeto protein estimation is offered to mother, which is helpful in determining any neural defect in the baby such as Down's syndrome.

At 20-24 weeks the midwife will train the patient to look for signs of early labour, pain and spasm or leaking of fluid in the lower part of the abdomen.

At 24-40 weeks, an ultrasound scan is performed to determine the progress and position of the baby. If the ball-like head is felt at the lower abdomen, this will be a pelvic delivery, but if the structure feels soft, then this could mean a breech. If it engages in the pelvis as breech, then an early caesarean section may be performed at 37-38 weeks.

If the blood sugar is high at 26-28 weeks and there is sugar in the urine, then a glucose tolerance test may be done to confirm gestational diabetes. If positive, appropriate action will be taken to control the blood-sugar monitoring after the baby is born.

At 28 weeks, a blood test for Rhesus antibodies is performed. If negative, an anti D injection is administered.

Between 36 weeks and delivery, the mother is made aware of how the birth will progress. The option of having a pain free labour by epidural analgesia will be discussed, as will overall safety with regard to the various delivery methods.

Sometimes if the head is down and the uterus does not contract well, suction is applied to the exposed part of the baby's head during delivery. If the head is bigger than the vaginal area, episiotomy (cut in the vagina) will be discussed at the time of delivery and following an anaesthetic block (pudendal block). The nerve is made numb so that the mother does not feel any pain.

At 40 weeks and beyond (post maternity) which is usually around two weeks before due delivery, an internal examination is done to assess the size of the cervix and whether it will be suitable for induction. If so, the mother is prepared for artificial rupture of the membrane and induction of labour.

Another will be admitted and fully examined, and a prostaglandin suppository will be inserted at night to dilate the cervix. In the morning, a cannula will be inserted into the arm vein and a dextrose/saline drip started to keep the vein open. The cervix is assessed and the membranes felt. If favourable, then the membrane is artificially ruptured and a syntocinon drip is started. This stimulates the uterus to contract.

Foetal heart monitoring equipment is placed on mum's abdomen to monitor foetal heart sounds. If there is a consistent dip, mum may be turned on her side with oxygen started. If there is still a dip, an emergency caesarean section is performed to prevent the baby from being harmed.

After a successful pregnancy, a post natal check up will be required at 6 weeks, to assess the blood pressure and size of uterus. This will include discussion about having a smear test and oral contraception for the future.

Pregnancy and Travel

If the pregnancy is uneventful and progressing well, there is usually no contraindication to travel between 18-32 weeks. The pressurised cabin of commercial planes is not a threat to the foetus. However, care should be taken in the first 10 weeks.

Plan your journey well ahead, and notify the airlines that you would like to have an aisle seat. Most airlines are non-smoking, but to be on the safe side, request a seat in the non-smoking zone.

Try and avoid malaria-infested zones and areas with infestation and yellow fever. Immunisation with live virus products like rubella, measles, yellow fever and activated polio, are contraindicated. Anti-malarials like Chloroquin or Proguanil, are safe in pregnancy. Purify the water, preferably with bacterial filtering systems. Do not use any antidiarrhoeal tablets but instead use oral rehydration fluids like deoralyte.

Morning Sickness and Vomiting

This is a common problem, and is most probably due to high oestrogen levels. It usually lasts around 4-5 months, but some may have it throughout their pregnancy. An unconfirmed study shows it to be more common in female babies.

Hyperemesis Gravidorum

Excessive vomiting can be very prohibiting and disabling, often causing dehydration and ketoacidosis in pregnant women, because of their inability to retain fluids. Sometimes it is severe, and admission to hospital to correct dehydration with intravenous fluids, may be necessary. Sometimes a deranged thyroid function can also cause this condition.

Treatment

A sympathetic attitude by the doctor can help enormously. An antacid such as Gaviscon can help ease the stomach lining and fresh lime is also good. Eating light meals often and in small amounts will also help.

Shocks of Pregnancy

The most shocking thing will be losing the baby through abortion. This could vary in type:

·  If the termination of the gestational products occurs in full before the 20th week of pregnancy, it is known as spontaneous abortion. About 70% of abortion happens in the16 weeks of pregnancy, and almost 18-20% of all pregnancies result in abortion.

·  Sometimes the fault is with the cervix which normally closes tight after pregnancy. If the pregnancy progresses and the cervix is incompetent, a stitch is put around it until delivery is imminent. This is known as Shirodker's suture.

Variation of Abortions

Threatened - There is usually cramp-like pain in the lower part of the abdomen and passage of blood from the vagina. This can occur as a physical symptom or be due to stress - the pregnancy continues, and the mouth of the neck of the womb (cervix) is closed. Rest for 48 hours is advised and counselling may be helpful. If the bleeding is more than an eggcupful, tampons should not be inserted.

Inevitable - This is so-called if the neck of the mouth of womb is open. The products of conception are not necessarily expelled but might be. Again, rest is advisable. Cramp-like pain and mild bleeding may continue. The pain is mainly due to the opening of the mouth of the neck of the womb (cervical dilation).

Breast Feeding

The breast milk contains all the nutrients needed for the baby to grow in the simplest form. It also contains antibodies that protect the baby.

·  Breastfeeding forms bond between mum and baby

·  Breastfed babies are less prone to eczema and diabetes

·  It has also been suggested that breastfed babies have lower blood pressure than those fed on bottles

·  Breastfeeding protects the baby from diarrhoea and abdominal upsets

·  The baby is also protected against chest infections

·  Breastfeeding provides a better mental development

Position for Breastfeeding

·  Sit on an upright chair with a straight back support

·  Make sure your lap is almost flat and level

·  Try and keep your feet as flat on the floor as possible - you can use a stool or a book to achieve this position

·  You can have the help of a pillow to support the baby and your arm

·  If you are feeding the baby lying down, then try to lie flat with a pillow under your head. Lie on your side with a pillow between the legs, keeping the baby as near to your body as possible

Dr. A. Bose
© allcures.com March 2003