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Pregnancy Issues / Precautions

Pregnancy Tips 
Tips to prevent nausea and morning sickness Eat more often but smaller amounts. Try not to go more than four hours between eating. Get out of bed slowly Keep biscuits handy to eat before getting out of bed Avoid large meals Rest as much as you can as feeling tiredness makes the feeling worse Try to avoid smells and food that make you feel worse Clean, lemony smells may make you feel better Avoid eating spicy or fatty foods Try to wear loose clothes that don’t put pressure on your stomach Tips to prevent heartburn Try putting a pillow between your knees to help ease the strain on hips and knees. Decrease your fluid intake in the evenings (but not during the day) and avoid caffeine to avoid heartburn. Eat little and often. Drink milk or herbal teas with chamomile or fennel after eating. Also eat peppermints after eating. Travel tips The second trimester is the best time to travel. At this time, you are probably over the sick and nauseous feelings of the first trimester. The miscarriage risk is also minimum at this time. On the road or in the air, avoid sitting for extended periods of time, try to walk around at least every hour or two. On a plane or train, even a trip up and down the aisles can help get your circulation going. Also make frequent trips to the toilet. Carry light snacks so that you do not go without food for long periods of time. Keep munching a carrot, an apple or a sandwich every hour or so. In the sultry heat of India, keep water handy all the time ot prevent dehydration and cramping. Use travel sickness bands – these work by massaging your pressure points. Miscellaneous If you suffer with piles during pregnancy ice packs covered with a soft cloth on the area can provide relief. To relieve backache, place a warm hot water bottle on the relevant area. Press your spine against a wall and keep in that position for a few seconds. For cramps, gentle exercise will help – swimming is particularly good. Raise your feet on a pillow when lying in bed. Pain relief during labour Having your back rubbed during labour helps with the pain. When you are in labour, try and walk around or at least stay in an upright position for as long as possible. This speeds up the process. Squatting, hands and knees or standing during delivery increases the pelvis size by over 30% giving you a faster, easier and safer delivery. Eating and drinking fluids during labour is the best natural remedy for labour pain. You can help your baby move into the optimal position for birth in your third trimester by making sure that your knees are lower than your hips when driving, sitting or relaxing. Diet and pregnancy

Pregnancy is a period of great physiological stress for the woman as she is nurturing a growing fetus in her body. It is time of increased nutritional needs, both to support the rapidly growing fetus and to allow for the changes occurring in the body. Throughout pregnancy, recommended intakes of many vitamins and minerals are higher than those recommended prior to pregnancy.

Fetal development is accompanied by many physiological, biochemical and hormonal changes occurring in the mother’s body which influence the need for various nutrients and the efficiency with which the body uses them. These changes include: Increased basal metabolic rate: Due to fetal growth and development there is an increase in the metabolic rate by about 5 % in the first trimester reaching to as high as 12 % during later stages of pregnancy, which in turn calls for increased caloric requirement.

Gastric changes: There is altered gastric function during pregnancy. Nausea, vomiting and constipation are very common during pregnancy.

Hormonal changes: during pregnancy there is increased secretion of certain hormones like aldosterone, thyroxin, growth hormone and parathyroid hormone.

Altered kidney function: due to fetal and maternal during pregnancy, there is an increased production of various waste materials like creatinine, urea and other waste products.

Choose food wisely:

Since there is an increased requirement of all the nutrients during pregnancy, it is suggested to consume a well balanced diet. A woman’s need for calories, protein, vitamins, minerals, and water all increase during pregnancy. With the exception of iron for many women, a careful selection of food can and should provide the additional calories and nutrients required. For healthy women, no special dietary supplements or foods are needed to ensure adequate nutrition. Your daily meals should consist of various food products from the different food groups, such as: Milk and milk products: Dairy products provide numerous nutrients and are especially high in calcium and proteins. Calcium is essential in the formation of bones and teeth. If your intake isn’t sufficient, your baby can withdraw calcium from your bones, making you more at risk of developing osteoporosis later in life. If you don’t like to drink milk, try flavouring it with chocolate or a drop of vanilla or serving it chilled over ice. The other ways to enhance milk intake is to take milk products in place of milk as such. These include curd, cheese, butter, etc. One cup of curds contains the same amount of calcium as a cup of milk, so include it with snacks and meals or substitute plain curd for some of the mayonnaise in salad dressings. Another way to add milk to your diet is to choose pudding desserts.

Cereals grains, dals and other pulses: Protein, a major nutrient in this group, is necessary for growth of new cells and replacement of old ones.

Vegetables: Vegetables provide vitamins A and C among other vitamins, minerals and fibre, which can help relieve constipation. Foods rich in Vitamin C are citrus fruits, cabbage, potatoes, spinach, green beans and tomatoes. Eating foods rich in Vitamin C helps the body absorb the iron in foods. The body does not store Vitamin C, so these foods are needed daily.

Fruits: Fruits such as oranges, grapefruit, melons and berries are the best sources of Vitamin C. Deep yellow fruits like papaya and mango are good sources of Vitamin A. It is easy to eat three or more servings of fruit a day: juice or fresh fruit for breakfast, fresh or dried fruit for a snack, a fruit salad with lunch and a fruit dessert with dinner. Meat, fish and poultry: This food group like cereals and pulses provide with proteins necessary for growth and development of the baby.

Recommended dietary allowances of various nutrients during pregnancy:

The nutrient needs are increased in view of the development of maternal organs such as uterus, placenta, breast tissue and to build up body reserves to be utilised at the time of delivery and subsequently during lactation.

However, an increased nutrient intakes has been suggested mainly in the second and third trimesters of pregnancy. The recommended levels of nutrient intake for women during the 2nd and 3rd trimesters of pregnancy are given in the table below:Group

Energy(Kcal) Protein(g)

Fat (g) Ca (g) Fe (mg) B-Carotene (micro g) Retinol (micro g) Vit. B1(mg) Vit. B2 (mg) Vit. B3 (mg) Vit. B6 (mg) Vit. B12 (micro g) Folic Acid (microg) Vit. C (mg) Light worker 2175 65 30 1.0 38 2400 600 1.1 1.3 14 2.5 1.5 400 40 Medium worker 2525

65 30 1.0 38 2400 600

1.3 1.5 16 2.5

1.5 400 40 Heavy worker

3525 65 30 1.0 38 2400 600 1.4 1.7 18 2.5 1.5 400 40

Drug usage during pregnancy

Pregnancy induces significant changes in the functions of the body’s systems and in its fluid and tissue composition. It is helpful to consider how these changes are likely to affect drug dosing and drug interactions in the pregnant women.

Drugs have effects on developing fetuses. Administered as an anti-anxiety and anti-nausea agent in the first trimester, thalidomide caused limb-reduction defects in one third of the fetuses exposed. The drug had been determined safe initially so several years passed and thousands of deformed infants were born before this was recognized.

The definition of a teratogen includes a broad range of abnormal development, including complete pregnancy loss, structural abnormalities, abnormal growth and long-term functional defects. Drug effects can be unexpected and delayed and can affect target organs at their time of most rapid development.

Drugs affecting the unborn child Alcohol

Chemotherapeutic agents (i.e., antimetabolites and alkylating agents)

Anticonvulsants (i.e., trimethadione, valproic acid, phenytoin, and carbamezapine)

Androgens

Warfarin

Danazol

Diethylstilboestrol

Lithium

Isotretinoin and other retinoids

Thalidomide

Athough nearly all drugs are present in breast milk following maternal ingestion, few are absolutely contraindicated or should be avoided by nursing mothers (i.e., amiodarone, aspirin, barbiturates, benzodiazepines, carbimazole, combined oral contraceptives, cytotoxic drugs, ephedrine, and tetracyclines).

The FDA has established five drug categories known to cause birth defects if taken during pregnancy Studies in women fail to demonstrate a risk to the fetus in the first trimester and the possibility of fetal harm seems remote (e.g., folic acid and levothyroxine).

Studies have shown an adverse effect that is not yet confirmed in women in the first trimester (e.g., amoxycillin and ceftriaxone).

Drugs to be given only if there is significant benefit ie. after seeking medical advice, as these dugs might have potential risk to the fetus (eg., nifedipine and omeprazole).

There is enough evidence of human fetal risk and only to be used in special medical conditions only if the doctor recommends (e.g., phenytoin and propylthiouracil).

These drugs should not to be used in women who are pregnant (e. g., misoprostol, warfarin, and isotretinoin). Their usage poses fetal abnormalities, or evidence of fetal risk. Antibiotics during pregnancy:

Those considered safe (i.e., penicillin and erythromycin base, stearate or ethylsuccinate)

Those that probably are safe but to be used with caution (i.e., azithromycin, metronidazole, nitrofurantoin)

Those that are contraindicated in pregnancy (i.e., tetracycline, fluroquinones, and erythromycin estolate) Drugs contraindicated during breast feeding Drugs Comments Anticancer drugs General hazards with the use of methotrexate and cyclophosphamide Bromocriptine Suppresses lactation Chloramphenicol Affects the bone marrow Ergot alkaloids Hazards of migraine Clemastine Drowsiness Phenindione Haemorrhage

Drugs that should be avoided or used with caution during pregnancy Drugs Comments Alcohol High dose may affect the infant Aminophylline Try to avoid Amiodarone Significant amounts present in milk Aminoglycosides Try to avoid Antibiotics Use with caution Aspirin Avoid high repeated doses Atropine Try to avoid Benzodiazepines Sedation with repeated doses Calciferol Hypercalcaemia in high doses Carbimazole Thyroid problems Chlorpromazine Drowsiness Clindamycin Bloody stools Corticosteroids Avoid high doses Corticosteroids Avoid high doses Diuretics Some may suppress lactation Iodine It is concentrated in milk Isoniazid Convulsions Laxatives Try to avoid them Lithium Avoid, but if used careful monitoring is required Meprobamate High milk concentration Metronidazole Discontinue breast feeding for 12-24 hours after a single dose, avoid breast feeding if repeated doses used Nalidixic acid Avoid as far as possible Nitrofurantoin Avoid them Opioid analgesics Withdrawal symptoms may occur in infants of addicted mothers Penicillin Safe except for allergy Phenobarbitone Drowsiness if used in high concentrations Reserpine Respiratory problems may occur Sex hormones Oestrogens, progestogens and androgens suppress lactation in high doses Sulphonamides Should be avoided as far as possible

Sex during pregnancy Is it safe to have sex during pregnancy? Does the sexual urge diminish during pregnancy? Is oral sex safe?

Pregnancy is the time when most women experience a change in their hormonal profile to such a degree that they may have to alter a lot of their regular activities to suit their mood at that time. Sex is one of those activities which might be the most affected. Many women do not enjoy sex at all during their pregnancy while others obtain maximum pleasure.

Is it safe to have sex during pregnancy?

Sex during pregnancy is totally safe if not otherwise advised by the doctor. Most women can have sex right until the last month of their pregnancy if they do not feel uncomfortable. It is safe to have intercourse since the baby is protected by a thick mucous plug that seals the cervix and guards against infection.

Some of the medical reasons which require abstaining from sex are:

Recent vaginal bleeding

Preterm labour

Ruptured membranes (broken water bag)

Placenta praevia

Infection with STDs

Does the sexual urge diminish during pregnancy?

Sexual urge is idiosyncratic and may increase or decrease when a woman is pregnant. Most women however, feel a decreased urge to have sexual intercourse, which may be more due to the presence of other symptoms during pregnancy like nausea and abdominal heaviness than due to actual decrease in sexual desire. Increased sexual desire may be due to increased blood flow to the pelvic area during pregnancy. There are changes in the hormonal profile also which may cause an increase in libido. Some women enjoy unrestrained sex since the fear of an unwanted pregnancy is removed.

The first trimester is usually the worst time for a woman to think about sex since most women experience breast tenderness and morning sickness during the first three months. They may also be tired both physically and emotionally due to the novelty of the situation. By the second trimester the situation eases considerably and couples are more likely to resume their normal sexual relations. However, these preferences are purely individual and may vary from one couple to another.

By the third trimester, physical discomfort is usually increased to a large extent. This may prompt couples to adopt alternate sexual positions so that the discomfort is alleviated. The “woman on top” position may be more suitable and enjoyable than the conventional “man on top” one. The rear entry position may also be tried out.

Is oral sex safe?

Oral sex, especially during the later months can be a very feasible alternative to intercourse. It may satisfy both partners without any potential discomfort. However, care should be taken that the male partner does not blow air into the vagina since it may cause blockage of a blood vessel which could be potentially dangerous. Oral sex should also be avoided if either of the partners has a sexually transmitted disease. Skin care during pregnancy Common skin conditions during pregnancy Tips for skin care

Pregnancy is a time of changes in the hormonal profile of the body that may contribute to changes in the skin. Since skin is the outermost layer of the body, even a slight change from the normal is evident. Pregnancy is also a time when special care should be taken to keep the skin healthy and glowing.

Many women frequently complain of dry skin due to over stretching but it is often taken as a normal part of pregnancy and no treatment is sought. However, some may also suffer from other skin conditions like herpes, itchy rashes, and mild discolouration.

Common skin conditions during pregnancy:

Melasma or ‘mask of pregnancy’ – it is a condition caused due to hormonal imbalance in the body during pregnancy. It is characterised by a discolouration of the skin, mostly on the forehead, nose and the upper lip. The skin on these areas becomes darker in colour (looking like a tan) and may be wrinkly and may fall off easily. This condition may affect as many as 70 percent of all pregnant women, especially those with darker complexions.

The condition is normally seen at the end of the second trimester or the beginning of the third. It does not have a specific modality of treatment, but exposure to the sun makes it worse. Thus women suffering from melasma should protect themselves against the sun by using potent sunscreens. In most cases, the marks vanish after the baby is born.

Urticaria of pregnancy – medically called puerperal urticaria of pregnancy (PUP), it is a condition of itchy rashes or hives that erupt usually in the third trimester of pregnancy. These rashes can be mildly or severely itchy, but usually disappear after delivery. Though they do not harm the mother or the baby, they are very irritating for the patient.

Hives during pregnancy is usually soothed with ointments that provide relief. Calamine lotion is usually able to provide much relief. Though drugs are usually not prescribed during pregnancy, anti-histamines may have to be given for itching in some cases.

Herpes gestationis – herpes infection during pregnancy is called herpes gestationis. It is characterised by the eruption of intensely itchy lesions on the skin that may be pus filled. This condition can occur anytime during the pregnancy but is most common during the second trimester. The rashes mostly begin on the abdomen and, then, spread to other parts of the body.

Acne and psoriasis – acne, in people who are prone to it, usually worsens during pregnancy. Psoriasis, on the other hand, tends to improve during pregnancy, but may flare up after delivery. Acne during pregnancy is usually ignored. Some drugs may be given to treat psoriasis, but they have to be taken only under the physician’s supervision.

Varicose veins – they are one of the most common complaints of pregnancy. Due to excess weight, most women develop varicose veins in their legs. Some may even have ‘spider veins’ on their face and chest. They usually vanish after delivery. Tips for skin care:

Apart from the medical conditions of the skin that may affect a pregnant woman, that have to be medically treated, some basic skin care methods can be adopted that will help to maintain healthy skin tone.

Sleep well – a proper sleep pattern during pregnancy is one of the best ways to maintain good and healthy skin. A well rested person appears healthier and this is especially so when a woman is pregnant since she gets tired easily.

Always use a sunscreen.

Clean face thoroughly – the face should be cleaned thoroughly since the skin of the face is usually oilier than the rest of the body. The pores of the face thus get clogged easily with dirt and cause pimples or acne. Cleaning the face regularly with a mild soap or face wash helps to prevent these conditions.

Moisturise often – since the skin is drier than usual during pregnancy, it helps to keep moisturising it often. Women with oily skin could use a water-based moisturiser while those with dry skin can use an oil-based one. It is always necessary to follow a cleaning and moisturising routine for healthy skin.

Get a facial massage – facial and body massage with mild and fragrant oils may help to relax apart from increasing blood circulation to the area.

Drink plenty of water – the water balance in the body should be maintained. This also affects the tone of the skin. Water cleanses the skin and removes the toxins from the body.

Smile and remain happy – the age old belief that smiling exercises more muscles of the face than a frown may also help. Happiness increases the blood flow inside the body and, thus, reflects in the form of a healthy and glowing skin. Cigarette smoking and alcohol intake How harmful is smoking during pregnancy? What is the effect of alcohol during pregnancy? How much alcohol is safe?

Pregnancy is a time when the mother has to take utmost care to ensure good health for herself and her baby. Smoking, drug abuse and alcohol consumption are an absolute no during pregnancy. During the first and last trimester, any of the above can cause irreparable damage to the baby.

How harmful is smoking during pregnancy?

Smoking any time during pregnancy is dangerous, but is exceptionally so during the first three months. Some of the conditions in the child that have been linked to maternal smoking are:

Congenital heart abnormalities

Small for date babies or premature birth

Still birth

Intellectual impairment

Attention deficit, hyperactivity and behavioural disorders

Learning disabilities

SIDS (sudden infant death syndrome)

MAS (Meconium Aspiration Syndrome) where the newborn has a greenish, sticky liquid in his intestines due to inhalation of amniotic fluid during pregnancy.

Besides active smoking, even passive exposure to smoke is dangerous during pregnancy. The mother-to-be should therefore ensure that she is not even around people who smoke, as far as possible.

There has been recent evidence to show that the effects of maternal smoking during pregnancy are seen even after the child has grown up. Adolescent children of mothers who smoked during their pregnancies seem to have behavioural problems at school.

What is the effect of alcohol during pregnancy?

Pregnancy is unlikely to occur in women who are chronic alcoholics because of cessation of menstruation due to liver damage. Even modest consumption of alcohol (2-4 drinks per week) has been associated with miscarriage.

Alcohol consumption during pregnancy has many side-effects. There are many conditions that may affect the child because of consumption of alcohol by the mother when she is pregnant. The most common and dangerous condition is called Fetal Alcoholic Syndrome (FAS). In this condition, the baby is born severely malformed and is usually mentally impaired. There may be defects in the heart, lungs and limbs. Children of about 10% of alcohol users develop this condition.

Other deforming conditions that may be caused due to heavy maternal consumption of alcohol may be:

Increased susceptibility for ear infections

Brain damage leading to mental retardation

Low birth weight

Difficulty in coordination

Facial deformities

How much alcohol is safe?

There is no safe level of maternal alcohol consumption for the safety of the fetus. Ideally, alcohol should be totally abstained from, especially during the first trimester. If this is not possible, then the drinks should be reduced to about 5 drinks per week. Travel during pregnancy Is it safe to travel by air? What precautions should be taken in car travel?

Pregnancy is a time when utmost care should be taken of the pregnant woman’s health, by her own self and by others around her. Though travel is certainly not prohibited during pregnancy, it may have to be undertaken with a few precautions so that the health of the mother and child is not compromised.

The doctor may prohibit the mother-to-be from travelling during the fist three months since at that time the risk of miscarriage is the highest. Travelling may also have to be avoided in case of high risk pregnancies or as advised by the doctor.

Is it safe to travel by air?

Most airlines have strict rules for pregnant travellers, wherein they are not permitted to travel if they are more than 32 weeks pregnant. Air travel may involve risk since the change in pressure may cause damage to the membranes of the uterus. Before embarking on a plane journey, the pregnant lady should take care to dress easily and follow the rules of the airline. It is also better not to take the non-pressurised cabins in the aircraft since a change in pressure is dangerous. It is also better to avoid the smoking areas in the aircraft.

What precautions should be taken in car travel?

Though traveling by car does not have any obvious disadvantages, longer journeys may be avoided especially during the first three months. This is because, the mother-to-be may not yet be used to the pregnancy and may get tired and fatigued easily.

Other tips to be kept in mind while traveling are: If the journey is long, frequent breaks (every hour preferably) are necessary to keep the circulation going in the body.

If the seat belt has to be worn, it should be worn low on the hips and not on the abdomen to avoid undue pressure.

Snacks should be carried on the journey to prevent the feeling of nausea and to maintain the energy levels in the body.

A pillow etc. should be carried to use during uncomfortable positions.

The doctor should give a clearance for travel before the journey. In case of travel to a foreign country, the requisite immunisations should be taken well before the date of travel to avoid any complications. Many countries require foreigners to undergo specific immunisations before visiting their country. This should be got out of the way as soon as possible since many immunisations have side effects like mild fever, pain in the area etc. It is also better not to travel to a place where there may be more chance of infection.

Complications during pregnancy – An overview Spontaneous abortion (Miscarriage) Ectopic pregnancy Hyperemesis gravidarum Placenta previa Abruptio placentae Erythroblastosis fetalis Multiple pregnancies

Pregnancies in which there is risk to the mother, foetus or the newborn baby, before, during or after delivery, are called high risk pregnancies. All pregnancies at a risk of being high-risk, are monitored from inception. The risk factors could range from maternal weight problem to diseases contracted during pregnancy.

What are the various abnormalities that increase the risks during pregnancy?

The most common abnormalities that affect pregnancy are:

Spontaneous abortion

Ectopic pregnancy

Pre-eclampsia and eclampsia

Placenta praevia

Erythroblastosis foetalis

Hyperemesis gravidarum

Multiple pregnancies

Spontaneous abortion (Miscarriage):

Termination of pregnancy that occurs before the 28th week is called abortion. When abortion is natural and not induced, it is called spontaneous miscarriage or abortion. If the pregnancy terminates between the 28th and 40th week, it is not called an abortion, but premature labour. The incidence of abortion is far higher than what is generally believed and may be as high as 30%.

The various causes of a miscarriage are: Abnormalities in the foetus

Intra uterine death due to infections contracted by the mother (eg. Smallpox, typhoid, dysentery etc.) and effects of X-rays or drugs

Abnormalities of the placenta

Abnormalities of the maternal genital organs. Ectopic pregnancy:

Pregnancies that occur when the fertilised egg implants itself outside the uterus are called ectopic pregnancies. Two kinds of ectopic pregnancies are most common – tubal pregnancy (when the egg gets implanted in the fallopian tubes) and ovarian pregnancy (when the implantation takes place in the ovaries). Tubal pregnancies often end in spontaneous abortion since the fallopian tubes do not have enough space for a foetus to grow. In such cases, the uterus is also enlarged and may look like a normal pregnant uterus of about 2 months. Women who already have a blockage in the tubes are more prone to ectopic pregnancy. Also, women who have had surgery to reverse tubal sterilisation are also at an increased risk of tubal pregnancy.

Ovarian pregnancies, though rare, are more difficult to detect than tubal pregnancies. In this, the sperm penetrates the egg before the latter has had a chance to come out of the ovary. Implantation takes place in the walls of the ovary. Hyperemesis gravidarum:

It is a condition characterised by excessive nausea and vomiting during pregnancy, which leads to weight loss. The pregnant woman remains dehydrated most of the time and has to be on medication. The patient may need to be hospitalised till the situation is brought under control. She is given liquid nutrition intravenously after which very light fluid diet may be resumed. The patient is under continuous medical supervision, and the doctor may have to terminate the pregnancy in rare cases. Usually, the pregnant woman is able to regain her lost weight once the condition is successfully treated.

Placenta praevia:

A complicated medical condition where the placenta covers the opening of the cervix into the vagina. In most cases, an early ultrasound may detect a low lying placenta, but the situation usually resolves itself as the uterus grows larger.

The condition may be detected by sudden and heavy vaginal bleeding towards the end of the second trimester. There is no pain and there may be danger to the life of the mother and the baby if the bleeding does not stop. In most cases of incessant bleeding, the baby is delivered by caesarean section if the pregnancy is beyond the 30th week. If the pregnancy is not in the last stages, the patient is advised complete bed rest and any kind of sexual arousal is avoided.

Abruptio placentae:

It is a condition in which the placenta begins to separate from the wall of the uterus before the end of pregnancy. It is a relatively rare condition and women with heart problems, high blood pressure and those who smoke are more at risk of developing detached placenta.

The main symptom of the condition is bleeding and cramps in the abdominal region, the severity of which depends on the extent of dislocation. In mild cases, the patient can resume her normal routine after some days of bed rest. Adequate rest is the most effective treatment for mild to moderate cases. In case the bleeding is very severe, immediate delivery is required to prevent any harm to the mother and the baby.

Erythroblastosis fetalis:

This is a condition caused by incompatibility of certain blood components of the mother and the baby. Also called Rh incompatibility, there is destruction of the fetal blood cells due to the antibodies transmitted from the maternal blood. The first child is usually normal and healthy. The effects are usually seen in subsequent children, when the antibodies are already present in the mother’s body. The scenario occurs when a woman with Rh negative blood group is impregnated by a man with Rh positive blood group and the foetus happens to be Rh +ve. The foetal blood causes antibodies to be generated in the mother’s body, which may be transferred to the subsequent babies.

Treatment measures aim at improving the immunity of the mother’s body. In some cases, the foetal blood may have to be transfused within the uterus. If the pregnancy proceeds without much problem, the baby will be delivered as normally as possible and the attending doctor will be prepared to transfuse the blood in the newborn if necessary.

Multiple pregnancies:

Though not a complicated pregnancy in the strictest sense, multiple foetuses may require more attention. Apart from competition for nutrition and space, multiple babies may be placed abnormally inside the uterus. In some cases, one baby may be head down (normal), while the other may be bottom down (breach baby). Some babies may also be entwined laterally (like a T). Pre-eclampsia & Eclampsia What is pre-eclampsia and eclampsia? What are the causes? Who is at greater risk? What are the complications associated with the problem? How is it diagnosed? What is the treatment? How can it be prevented?

What is pre-eclampsia and eclampsia?

Pre-eclampsia and eclampsia are conditions associated with high blood pressure, loss of protein in the urine and swelling of the body that occur during pregnancy. Pre-eclampsia is also called toxaemia of pregnancy which may develop into eclampsia if it is complicated by fits. These conditions usually develop in the second half of pregnancy though sometimes they develop shortly after birth.

What are the causes?

The exact cause of this problem is not known. The disorder is at any rate triggered by one or more substances produced by the placenta (the afterbirth), which induce a generalized reaction in the pregnant woman. One of the main features of this reaction is a constriction of the small arteries of the body.

What are the symptoms?

Rapid weight gain

Swelling of the feet, ankles, hands and face

Headache and dizziness

Ringing in the ears

Abdominal pain

Decreased production of urine

Nausea and vomiting

A state of confusion.

Who is at greater risk?

Women who are pregnant for the first time

Women who have a family history of such a problem

Women who are 40 years old or more

Women with pre-existing high blood pressure

Obese women

Women expecting twins or triplets.

What are the complications associated with the problem?

A very high blood pressure interferes with the placenta’s ability to transfer oxygen and nutrients to the baby resulting in a low birth weight baby with other developmental problems.

Very high blood pressure can cause malfunctioning of the kidneys.

There can be destruction of the red blood cells, disturbed liver function and a decrease in the number of platelets (blood cells that play a key role in the clotting process). A decreased platelet count can lead to uncontrollable bleeding during delivery.

If the blood pressure is not kept under control it can lead to eclampsia wherein the woman develops fits leading to a decreased supply of oxygen to the baby. The placenta ( the afterbirth) may also start to separate from the wall of the uterus.

How is it diagnosed?

A woman’s blood pressure is always measured at every visit to the doctor and a record is maintained. If the diastolic (lower reading) blood pressure is found to be high (95mmHg or more instead of the normal 80mmHg) and the systolic (upper reading, 150-160mmHg instead of the normal 120 mmHg) or if there is protein in the urine as diagnosed by urine examination, the condition is called pre-eclampsia.

What is the treatment?

The treatment of pre-eclampsia is bed rest and as soon as the foetus has a good chance of survival outside the womb the doctor should decide on delivery. Careful monitoring of blood pressure, weight and urine checks for protein are needed. Delivery can be induced in the following instances:

The diastolic blood pressure increases from 80mmHg (normal) to 100 or 110mmHg consistently for a 24-hour period.

Persistent or severe headache.

Pain in the abdomen.

Abnormal liver functions as diagnosed by the tests.

Abnormal foetal heart rate.

How can it be prevented?

There are no known preventive methods for this condition. An early diagnosis through regular visits to the doctor during pregnancy thus becomes important.

Taking a calcium tablet daily in pregnancy may possibly somewhat decrease the risk of developing these disorders. Insufficient sleep tied to post- pregnancy weight

Lack of sleep after childbirth can lead to excess weight retention after pregnancy.

A majority of women experience an increase in weight after pregnancy. And many find it tough to reduce this excess weight and get back to shape. Besides diet and physical activity, there are many other factors that influence weight retention during childbirth. Sleep is believed to be one such factor. Inadequate and poor quality sleep can create problems for a lot of woman after childbirth.

To assess the relationship between weight retention and sleep, American researchers studied pre and post-pregnancy weight among 940 women in eastern Massachusetts and determined sleep patterns through questionnaires and interviews.

The results showed that women who got less than an average of 5 hours of sleep daily during the first 6 months after childbirth were likely to weigh at least 5 kilograms (about 11 pounds) more than their pre-pregnancy weight, one year after childbirth. Overall, 12 percent of the women reported 5 hours or less sleep per day while 30, 34, and 24 percent, respectively, received 6, 7, and 8 or more hours a day. The women who slept 5 hours or less, on average, during the first 6 months after childbirth were 2.3 times more likely than those who got 7 hours of sleep to retain at least 5 kilograms of weight at one year. This possibility was seen as increasing to three-folds after adjusting for factors such as the mother’s pre-pregnancy body mass index, diet, breastfeeding pattern, physical activity level, number of children, race, age, and education level. Therefore, it is very important for women to get enough sleep to prevent excess weight retention after childbirth.

Caffeine increases the risk of miscarriage As compared to women who avoid caffeine, those who drink two or more cups of coffee have a higher risk of having a miscarriage. Caffeine is known to have various side effects. It is believed that women who are pregnant or are actively trying to become pregnant should stop drinking coffee for three months or hopefully throughout pregnancy. Caffeine is harmful because it stresses the fetus’ immature metabolism. It can also decrease blood flow in the placenta, which could harm the fetus.

To examine the correlation between caffeine and the risk of miscarriage in pregnant women, researchers in the US studied 1,063 pregnant women who were members of the Kaiser Permanente health plan in San Francisco, for a period of 2 years. The women in this group never changed their caffeine consumption during pregnancy.

In the results, it was found that was women who consumed the equivalent of two or more cups of regular coffee or five 12-ounce cans of caffeinated soda – were twice as likely to miscarry as pregnant women who avoided caffeine. This risk appeared to be related to the caffeine, rather than other chemicals in coffee, because they also saw an increased risk when the caffeine was consumed in soda, tea, and hot chocolate.

Therefore, it can be said that high doses of caffeine during pregnancy significantly increase the risk of miscarriage. And pregnant women should avoid caffeine consumption as far as possible.

Dental X-rays may lead to low birth-weight Pregnant women who undergo dental X-rays may increase their risk of having low birth-weight babies. The association could be related to exposing the mothers’ thyroid, pituitary or hypothalamus glands to radiation, even early in the pregnancy. Till now, people assumed that head and neck radiation will not have any adverse effect on pregnant women. People assume that only direct radiation to the uterus or the foetus can lead to adverse pregnancy outcomes. A seven-year review of a dental insurance company’s records in the state of Washington found pregnant women who underwent extensive dental X-rays were at three times the risk of having a low birth-weight baby, characterized as weighing 5.5 pounds (2.5 kg) or less. Some 20 percent of the 5,585 infants in the study had low birth weight. Researchers from the University of Washington in Seattle conducted a study, which divided women into three groups, with the highest level of radiation exposure from dental X-rays comparable to that received in four to 16 round-trip flights between New York and London. Women may not always be aware of their pregnancy status, so it may not be possible to eliminate all dental radiography during pregnancy, but if this goal could be achieved and if the identified association is causal, the prevalence of low birth-weight infants could be reduced by up to 5 percent.

Fish oil supplements in pregnancy

Fish oil supplements taken during pregnancy are safe and may have beneficial effects on the child. Fish oil supplements are known to provide a lot of health benefits. When taken during pregnancy, these supplements can help prevent allergies in babies at high risk. In general, pregnant women are advised against taking any medication or supplement unless the benefit is known to outweigh any potential risk to the fetus. Pregnant women should always consult their doctor before taking drugs or supplements. But in the case of fish oil, previous studies have shown associations between fish oil supplements during pregnancy and improved attention and mental processing in the young children.

To assess the efficacy of fish oil supplements during pregnancy, Australian researchers assessed the effects of prenatal omega-3 LC PUFA on cognitive development in 72 children whose mothers received either high-dose fish oil or olive oil during pregnancy. The results showed significant increases in omega-3 LC PUFAs in the umbilical cord blood of infants in the fish oil group compared with those in the control group, whereas omega-6 fatty acid content in the fish oil group was significantly decreased. Moreover, eye and hand coordination scores were significantly higher among children in the fish oil group than among the control. Growth measurements of the children at 2.5 years old, as well as other subscales of development, did not differ between the fish oil and control groups. And to add to this, the two groups had similar scores on language and behaviour scales. These findings suggest that supplementation with a relatively high-dose fish oil during the last 20 weeks of pregnancy is not only safe but also seems to have potential beneficial effects that need to be explored further.

Miscarriage leads to trouble in next pregnancy Pregnant women who suffer a miscarriage in the second-trimester are at high risk of repeat second-trimester miscarriage or spontaneous preterm birth during a subsequent pregnancy. American researchers studied three groups of women from 2002 to 2005: 38 women who had a spontaneous second-trimester miscarriage; 76 women with a spontaneous preterm birth; and 76 women with full-term deliveries. All of the women had a subsequent pregnancy beyond 14 weeks’ gestation.

The frequency of subsequent second-trimester loss was highest (27 percent) in women who suffered a second-trimester loss in the first pregnancy. The frequencies of subsequent second-trimester loss were 3 percent and 1 percent in the spontaneous preterm birth, and full-term delivery groups, respectively. Corresponding frequencies of subsequent spontaneous preterm birth were 33 percent, 40 percent and 9 percent for the three groups, respectively.

Of great clinical concern is that women with prior second-trimester pregnancy loss have a high frequency of very early preterm birth. In this group, spontaneous preterm birth at less than 28 weeks was 10 percent, versus 1 percent in the other two groups.

The researchers suggest that the biologic mechanism for second-trimester losses may be similar to that of spontaneous preterm birth, possibly related to cervical ripening as a primary event. If so, women with second-trimester loss would be candidates for therapy that reduces subsequent preterm birth.

Vitamin D deficiency linked to problems in pregnancy

Vitamin D deficiency during pregnancy can lead to complications both for the mother and the fetus. Deficiency of vitamin D during pregnancy has been linked with a number of serious short and long-term health problems in the offspring, including impaired growth, skeletal problems, type 1 (or insulin-dependent) diabetes, asthma and schizophrenia. Low levels of vitamin D in expectant mothers can also increase their risk of pre-eclampsia. Pre-eclampsia is a condition of pregnancy that usually begins with high blood pressure. The disorder may also lead to seizures, kidney failure or stroke. It slows the growth of the fetus, can cause early delivery and can be fatal for the mother and the infant. Its cause is unknown and there is no treatment, except to manage the symptoms. To assess the relationship between vitamin D and pre-eclampsia, researchers at the University of Pittsburgh measured vitamin D levels in banked sera from 55 pregnant women who developed pre-eclampsia and from 219 who did not. The average vitamin D level for women who developed pre-eclampsia was 45.4 nmol/L compared with 53.1 nmol/L in the control group. The results showed that women who developed pre-eclampsia had vitamin D concentrations that were significantly lower early in pregnancy compared to women whose pregnancies were normal. Even though, vitamin D deficiency was common in both groups, the deficiency was more prevalent among those who went on to develop pre-eclampsia. It was also found that the risk of pre-eclampsia increased with decreasing levels of vitamin D in early pregnancy. Thus, vitamin D supplementation in early pregnancy can be explored as a safe and effective means of preventing pre-eclampsia and promoting well-being of the newborn.

Eating disorders and pregnancy

Some women can develop binge eating disorder in pregnancy. While certain women recover from eating disorders during pregnancy, there also exist some who develop new disorders. Binge eating is one such disorder, characterised by eating an unusually large amount of food and feeling out of control. It needs to be distinguished from the normal increase in appetite that occurs in pregnancy. People with the condition do not make themselves vomit or engage in other purging behaviour. To assess the relationship between eating disorders and pregnancy, researchers at the University of North Carolina studied 41,157 pregnant women, who were enrolled at approximately 18 weeks’ gestation and had valid data from the Norwegian Medical Birth Registry. Before pregnancy, 0.1 percent of women had anorexia nervosa, 0.7 percent had bulimia nervosa, 3.5 percent had binge eating disorder, and 0.1 percent purged without binging. The results showed that pregnancy could be a catalyst in the development of some eating disorders. It was found that among women who purged without binging before pregnancy, 78 percent stopped doing so while pregnant. Thirty-nine percent of women with binge eating disorder recovered during pregnancy, as did 34 percent of those with bulimia nervosa. While it was rare for women to develop a purging disorder or bulimia nervosa for the first time while pregnant, 711 women did develop binge eating disorder for the first time. Women with a higher body weight, less education and lower income were more likely to begin binging, as were those who smoked cigarettes, had more previous pregnancies, or had at least one previous abortion. Thus, pregnancy may be a time when women need to be on guard against developing eating disorders.

Pregnancy and nightmares

During pregnancy and often after giving birth, women commonly experience anxious dreams of their new infants being in danger. The intense physical, hormonal and emotional changes surrounding pregnancy and childbirth likely play a role in infant-related dreams and associated behaviour in new mothers and moms-to-be. Such dreams appear to be common reactions to the potentially overwhelming situation of new motherhood, in particular to the combination of chronically disrupted sleep and the intense pressures of maternal responsibility. In one particular type of dream, it so happens that the mother acts out a dream of looking frantically for her lost infant in the bed, groping through the sheets, sometimes waking up the husband, and sometimes crying out in alarm to ‘watch out the baby is lost in the bed somewhere.’ The vividness of this so-called baby-in-bed dream often reaches hallucinatory proportions. To assess the sleep patterns of pregnant women, researchers at the Sleep Research Centre at the Sacre-Coeur Hospital in Montreal, Quebec, Canada, analysed dream-associated behaviour in 202 women who had recently given birth, 50 pregnant women, and 21 control women who were not pregnant and had never given birth.

The results showed that pregnant women and those who had recently given birth were equally likely to recall infant dreams and nightmares, but more women with newborns reported that their dreams were riddled with anxiety (75 percent) and with visions of their infant in trouble (73 percent) than did pregnant women (59 percent and 42 percent, respectively). As compared to women who were yet to deliver, women after delivery reported dream enacting behaviour like moving about in the bed, speaking, expressing emotions.

The occurrence of pregnancy and postpartum infant dreams and associated behaviour may reflect the pervasive emotional influence of maternal concerns or changes instigated by severe sleep disruption, lack of deep sleep characterised by rapid eye movements and altered hormone levels.

Conception and pregnancy Physiology of the female reproductive system What is the menstrual cycle? How to know your fertile period? Tips to help a woman conceive When you come off the pill

Physiology of the female reproductive system

The female reproductive system consists of the external and the internal genitalia. The external genital organs are visible outside the body and begin to mature when a girl reaches puberty. The internal genitalia are the organs where fertilisation and conception takes place. The uterus, fallopian tubes, ovaries and the vagina are the main structures of the female reproductive system. The organs of sexual reproduction are the gonads, which are the ovaries in females and the testes in males. Females produce female gametes or eggs (males produce male gametes or sperms). Sexual reproduction is the fertilization of a female gamete by a male gamete.

When a female is born, each of her ovaries has hundreds of thousands of eggs, but they remain dormant until her first menstrual cycle, which occurs during puberty. At this time, during adolescence, the pituitary gland secretes hormones that stimulate the ovaries to produce female sex hormones, including oestrogen, which helps the female develop into a sexually mature woman. Also, at this time, females begin releasing eggs as part of a monthly period called the menstrual cycle. Approximately once a month, during ovulation, an ovary discharges a tiny egg that reaches the uterus through one of the fallopian tubes. Unless fertilised by a sperm while in the fallopian tube, the egg dries up and is expelled from the uterus. If a female and male have sexual intercourse within four days of ovulation, fertilisation can occur. When the male ejaculates semen is deposited into the vagina. Between 200 and 300 million sperm are in this small amount of semen, and they ‘swim’ up from the vagina through the cervix and uterus to meet the egg in the fallopian tube. Only one sperm is required to fertilise the egg.

What is the menstrual cycle?

The menstrual cycle is the way a woman’s body gets ready for the possibility of pregnancy each month. A cycle is counted from the first day of one period (menstruation) to the first day of the next. An average cycle is 28 days, but anywhere from 23 to 35 days is normal. The day that bleeding starts is counted as the first day of a given cycle. The menstrual cycle is controlled by hormones released by the hypothalamus the pituitary gland and the ovaries.

The menstrual cycle has four stages: The menstrual phase When a women is having her period it means that the lining of the uterus is breaking down and slowly flowing out of her body through the vagina over a period of days called the menstrual phase. Menstruation is the term given to the periodic discharge of blood, tissue, fluid and mucus from the reproductive organs of sexually mature females. The flow usually lasts from 3 – 6 days each month and is caused by a sudden reduction in the hormones, estrogen and progesterone. For most of a woman’s life, the egg that is released approximately once each month will not become fertilised, so the lining that develops each month for the possibility of a fertilised egg cell won’t be needed. Over a period of days the blood vessels shrink and the uterus will shed the unneeded lining, made up of a small amount of blood and tissue.

The preovulatory phase The preovulatory phase (before the egg cell is released) is next and starts as soon as the menstrual phase (the period) has ended. During the preovulatory phase the uterine lining thickens with an increased numbers of blood vessels. The lining of the uterus needs to prepare itself for the possibility of supporting a fertilised egg. An egg is also ripening in one of the ovaries in preparation for ovulation.

The ovulation phase The third phase is the ovulation phase at midcycle, which in a 28-day cycle would be day 14. A mature egg is released from one of the ovaries during ovulation. Some women may have some slight discomfort during ovulation usually described as a twinge or cramp in the lower abdomen or back. Many women have no sensation that they are ovulating. Once released the egg travels into the fallopian tube and then begins a four to five day journey to the uterus. The egg lives twelve to twenty-four hours in the fallopian tube after it has been released from the ovaries and then disintegrates if not fertilised. Sperms can survive for up to five days inside a woman’s reproductive system. The few days before, during and after ovulation are a woman’s “fertile period” – the time when she can become pregnant. Because the lengths of menstrual cycles vary, many women ovulate earlier or later than day 14 of the cycle. Stress and other things can sometimes cause a cycle to be shorter or longer. This event occurs approximately once a month near the midpoint of a woman’s menstrual cycle.

The postovulatory phase Most months the egg cell simply dies in the postovulatory phase (after the egg cell is released), the endometrium continues to develop and the uterine glands secrete nutrient materials. If the egg cell meets a sperm cell and is fertilised by a sperm it attaches to the uterus. Fertilisation usually occurs when the egg is in the fallopian tube. If a woman becomes pregnant her menstrual cycle will stop during the time that she is pregnant. If conception doesn’t occur, the hormone levels drop. Below a certain level of hormones, the uterine lining can no longer be maintained and the lining of the uterus breaks down, menstruation begins, and the cycle repeats. How to know your fertile period?

A woman is most fertile during mid cycle. Ovulation generally occurs 14 days before the start of the next period. To successfully conceive, it is best to have intercourse in the fertile window of opportunity starting at about 2-3 days before ovulation. Usually, the fertile period in a woman, with a 28 days cycle, extends from day 11 to day 18. It is important to keep a track of your periods. Mark the calendar on the day you get your period. This is Day One. Count each day until your next period arrives. You may need to do this for three or four months to get an accurate measure of the length and regularity of your cycle.

If your cycles are very regular, you may be able to determine when you ovulate: in the average menstrual cycle, ovulation occurs 14 days before the menstrual period arrives – or on day 14 of a 28-day cycle. So if you subtract 14 days from the length of your cycle, you’ll get an idea of when you ovulate.

Use the Ovulation calculator in the pregnancy section to determine the the most likely date of your ovulation.

If your cycles are not very regular, or you’d like a more accurate picture of your ovulation then:

1. Track your temperature: One of the indications that ovulation has occurred is that a woman’s basal body temperature increases slightly during ovulation. You can detect this ‘thermal shift’ by taking your temperature every morning at the same time before you get out of bed. If you chart your temperature each day for a few months, you’ll begin to see a pattern that will help you predict when you are about to ovulate. Most women’s temperature increases about a half a degree 24 to 48 hours after ovulation.

2. Watch for changes in your cervical mucus: This method does not exactly pinpoint but gives you some indication of whether you’re in a fertile period or not. As your body prepares to ovulate, it produces larger quantities of thin, clear cervical mucus, a substance that smoothes the way for the sperm to meet the egg. On your most fertile days, just before ovulation, the mucus will appear clear, stretchy, and slippery. After ovulation, when your fertile days are past, the mucus usually becomes thicker and then gradually dries up. Tips to help a woman conceive

Being healthy and having regular menstrual cycles increases the chances of conceiving a healthy baby and carrying the baby to full term. Basic health tips include

Don’t smoke

Avoid alcohol

Reduce coffee consumption

Eat a healthy and nourishing diet

Manage stress levels

Exercise regularly If you’re under 35 and have had regular intercourse for 12 months, or 35 or older and have been trying for six months, then it’s time to see the doctor for a fertility evaluation.

When you come off the pill

If you have just come off the contraceptive pill and are ready to have a baby, be prepared for the fact that conception may not happen straight away. The hormones in the pill have been running and regulating your menstrual cycle, not your body. When you come off the pill it takes a little while for your body to regain its natural hormonal rhythm which varies from one woman to another. Complications during pregnancy – An overview Spontaneous abortion (Miscarriage) Ectopic pregnancy Hyperemesis gravidarum Placenta previa Abruptio placentae Erythroblastosis fetalis Multiple pregnancies

Pregnancies in which there is risk to the mother, foetus or the newborn baby, before, during or after delivery, are called high risk pregnancies. All pregnancies at a risk of being high-risk, are monitored from inception. The risk factors could range from maternal weight problem to diseases contracted during pregnancy.

What are the various abnormalities that increase the risks during pregnancy?

The most common abnormalities that affect pregnancy are:

Spontaneous abortion

Ectopic pregnancy

Pre-eclampsia and eclampsia

Placenta praevia

Erythroblastosis foetalis

Hyperemesis gravidarum

Multiple pregnancies

Spontaneous abortion (Miscarriage):

Termination of pregnancy that occurs before the 28th week is called abortion. When abortion is natural and not induced, it is called spontaneous miscarriage or abortion. If the pregnancy terminates between the 28th and 40th week, it is not called an abortion, but premature labour. The incidence of abortion is far higher than what is generally believed and may be as high as 30%.

The various causes of a miscarriage are: Abnormalities in the foetus

Intra uterine death due to infections contracted by the mother (eg. Smallpox, typhoid, dysentery etc.) and effects of X-rays or drugs

Abnormalities of the placenta

Abnormalities of the maternal genital organs. Ectopic pregnancy:

Pregnancies that occur when the fertilised egg implants itself outside the uterus are called ectopic pregnancies. Two kinds of ectopic pregnancies are most common – tubal pregnancy (when the egg gets implanted in the fallopian tubes) and ovarian pregnancy (when the implantation takes place in the ovaries). Tubal pregnancies often end in spontaneous abortion since the fallopian tubes do not have enough space for a foetus to grow. In such cases, the uterus is also enlarged and may look like a normal pregnant uterus of about 2 months. Women who already have a blockage in the tubes are more prone to ectopic pregnancy. Also, women who have had surgery to reverse tubal sterilisation are also at an increased risk of tubal pregnancy.

Ovarian pregnancies, though rare, are more difficult to detect than tubal pregnancies. In this, the sperm penetrates the egg before the latter has had a chance to come out of the ovary. Implantation takes place in the walls of the ovary. Hyperemesis gravidarum:

It is a condition characterised by excessive nausea and vomiting during pregnancy, which leads to weight loss. The pregnant woman remains dehydrated most of the time and has to be on medication. The patient may need to be hospitalised till the situation is brought under control. She is given liquid nutrition intravenously after which very light fluid diet may be resumed. The patient is under continuous medical supervision, and the doctor may have to terminate the pregnancy in rare cases. Usually, the pregnant woman is able to regain her lost weight once the condition is successfully treated.

Placenta praevia:

A complicated medical condition where the placenta covers the opening of the cervix into the vagina. In most cases, an early ultrasound may detect a low lying placenta, but the situation usually resolves itself as the uterus grows larger.

The condition may be detected by sudden and heavy vaginal bleeding towards the end of the second trimester. There is no pain and there may be danger to the life of the mother and the baby if the bleeding does not stop. In most cases of incessant bleeding, the baby is delivered by caesarean section if the pregnancy is beyond the 30th week. If the pregnancy is not in the last stages, the patient is advised complete bed rest and any kind of sexual arousal is avoided.

Abruptio placentae:

It is a condition in which the placenta begins to separate from the wall of the uterus before the end of pregnancy. It is a relatively rare condition and women with heart problems, high blood pressure and those who smoke are more at risk of developing detached placenta.

The main symptom of the condition is bleeding and cramps in the abdominal region, the severity of which depends on the extent of dislocation. In mild cases, the patient can resume her normal routine after some days of bed rest. Adequate rest is the most effective treatment for mild to moderate cases. In case the bleeding is very severe, immediate delivery is required to prevent any harm to the mother and the baby.

Erythroblastosis fetalis:

This is a condition caused by incompatibility of certain blood components of the mother and the baby. Also called Rh incompatibility, there is destruction of the fetal blood cells due to the antibodies transmitted from the maternal blood. The first child is usually normal and healthy. The effects are usually seen in subsequent children, when the antibodies are already present in the mother’s body. The scenario occurs when a woman with Rh negative blood group is impregnated by a man with Rh positive blood group and the foetus happens to be Rh +ve. The foetal blood causes antibodies to be generated in the mother’s body, which may be transferred to the subsequent babies.

Treatment measures aim at improving the immunity of the mother’s body. In some cases, the foetal blood may have to be transfused within the uterus. If the pregnancy proceeds without much problem, the baby will be delivered as normally as possible and the attending doctor will be prepared to transfuse the blood in the newborn if necessary.

Multiple pregnancies:

Though not a complicated pregnancy in the strictest sense, multiple foetuses may require more attention. Apart from competition for nutrition and space, multiple babies may be placed abnormally inside the uterus. In some cases, one baby may be head down (normal), while the other may be bottom down (breach baby). Some babies may also be entwined laterally (like a T). Anatomy of the female reproductive system

The female reproductive system consists of the external and the internal genitalia. The external genital organs are visible outside the body and begin to mature when a girl reaches puberty. The internal genitalia are the organs where fertilisation and conception takes place.

The external genitalia

The vulva : The area starting below the navel and consisting of the external genitalia is called the vulva. The skin of the area is covered with pubic hair which begins to grow around 12 years of age. The vulva includes the following organs:

The labia majora – literally meaning “large lips”. The labia majora are two folds of skin that flap over the other external genitalia. This skin has sweat glands and other specialised glands which produce a characteristic smell. They are covered with pubic hair.

The labia minora – meaning “small lips”. These structures lie within the labia majora and flank the opening of the vagina and the urethra. They have some erectile tissue which makes them sensitive to touch. At the upper end, they unite to form prepuce to cover the clitoris.

The clitoris – this is the structure analogous to the penis in the male. It is the most sensitive genital structure in the female and is covered by the prepuce. It has a rich supply of blood vessels and nerve endings. When adequate stimulation is provided, it becomes erect. The area around it becomes thick and bulbous due to a rush of blood.

Bartholin’s gland – this gland is located inside the vaginal opening, behind the labia minora. It is imperceptible when healthy and produces a thin mucus that provides lubrication to the vaginal opening during sexual stimulation.

The hymen – the ‘maidenhead’ is a membrane composed of connective tissue that forms a tight ring around the vaginal opening. The hymen is an elastic structure that in some cases, completely covers the vaginal opening. It gets torn during the first sexual intercourse. However, it is not a reliable parameter of virginity since it is elastic might not be torn all through a woman’s life. It may also get torn during other physically strenuous activities.

The internal reproductive organs

The vagina

The vagina is a muscular canal that connects the external organs with the uterus. Its average length is about 10 cm, but only the outer one third of it is sexually responsive. The upper end of the vagina, adjoining the uterus, is the cervix.

The vagina does not have any glands and it is kept moist by the lubrication provided by the cervical and uterine glands. During a woman’s reproductive years, the lining of the vagina seems irregular and somewhat corrugated. Before puberty and after menopause, the lining becomes smooth due to a lack of hormone production. The vagina is naturally protected against infections due to lactic acid secretion after puberty.

The uterus

The uterus is a pear shaped organ, weighing about 70 gm and is approximately 7.5 cm long in an adult female. It has thick muscular walls with a rich supply of blood vessels. The embryo, during conception, implants itself in the uterine cavity and grows there. At the upper end, the uterus opens out into the Fallopian tubes, while the lower end continues into the cervix.

The lining of the uterus is made up of epithelial cells and is called the endometrium. The cells of the endometrium are shed during menstrual periods. When a woman is pregnant, the endometrium is engorged with blood and provides a cushion for the growing baby.

The Fallopian tubes

The Fallopian tubes, also called the uterine tubes, connect the ovaries with the uterus. They are about 10 cm in length and 8 mm in diameter. The fertilised egg moves down the Fallopian tubes to the uterus where it becomes implanted. The lining of the tubes has cilia or hair like structures that move and propel the egg towards the uterus.

The ovaries

The ovaries are two almond shaped organs that produce ova or eggs during ovulation. They are small in children, but begin to grow during puberty due to changes in the hormonal profile.

The cells of the ovaries form a mass known as a follicle. The follicle continues to grow during a menstrual cycle and on the 14th day of the cycle, the egg is released from this follicle. Though many follicles ripen at the same time, usually only one of them matures enough to release the ovum. The egg is then released into the Fallopian tubes from where it travels towards the uterus. If it is fertilised by a sperm on the way, pregnancy results. Otherwise, the ovum degenerates and is expelled with the menstrual blood.

The sex hormones

All the changes that occur in a woman’s reproductive system during puberty are, to a large extent, determined by the changes in the hormonal profile. The two main female hormones, produced by the ovaries – oestrogen and progesterone, begin to have a sexually maturational effect at the time of puberty. When the pubertal growth spurt occurs, the brain sends signals to the hypothalamus, a gland in the brain, and the ovaries to start producing the female hormones.

Sex hormones are responsible are responsible not only for the maturation of the primary sexual organs, but also for the production of secondary sexual characteristics like formation of body hair, growth of breasts, changes in voice and deposition of fat in the body.

Fetal Development The first three months The next three months The last three months

How is pregnancy detected?

The first sign that indicates to most women that they may be pregnant, is the stopping of their monthly periods. The uterus is preparing for the incumbent baby by thickening its lining and making it receptive to the implantation of the embryo. The pituitary gland produces hormones that stimulate the ovaries to produce eggs, which if fertilised, move through the fallopian tubes into the uterus.

Pregnancy is divided into three trimesters (three months). The first and the last trimesters are times of extra precaution for the mother-to-be, since the baby is at the most vulnerable at these times.

The first three months

Month 1 – the month starts with the implanting of the embryo in the lining of the uterus. It is still not called a ‘fetus’, since it is nothing more than a mass of cells. These cells start differentiating to form specialised structures which will become the amniotic sac, the placenta and the baby itself. By the end of the first month, the embryo is about one tenth of an inch long (the size of a grain of rice). A primitive brain and spinal cord begin to form and the heart starts beating. There is no perceptible change in the body proportions of the expectant mother. In fact, the first month usually slips by undetected. By the end of the month, the mother may start feeling nauseous in the morning, a condition termed as “morning sickness”.

Month 2 – the embryo begins to grow in length. By the end of the second month, it is almost an inch long. The brain and the spinal cord are almost completely formed. The heart gets divided into two chambers and circulation begins. Veins are clearly visible. Buds form at the place where arms and legs are going to develop later. These buds have a webbed appearance. Blackened dots form near the eye sockets by the beginning of the month. All the major organs have started to develop by the end of the second month. The umbilical cord and the placenta also start forming.

In the mother-to-be, the breasts enlarge and the nipples become more prominent. There may be some tenderness and pain in the area due to an increase in the body hormones. There may be increased vaginal secretion and the mucous plug begins to form. The expectant mother may feel an increased urge to urinate because of increased pressure from the uterus due to the growing fetus.

Month 3 – the embryo in the third month is technically called the fetus. The fetus is now longer and the external features begin to be distinguished. The fetus has started to resemble a human baby. The internal organs are largely formed but not fully developed. The fetus may start responding to sounds and may startle, but the movement is not perceptible due to its small size. By the end of the third month, the fetus is approximately 3 inches long and weighs a little more than a grape. The baby’s heart beat can be heard by an instrument called a doppler.

Morning sickness in the mother may stop. She may feel hungry more often and may have mood swings. The uterus is now big enough and the mother may feel heaviness in the abdomen.

The next three months

Month 4 – The mother may feel the baby’s first kick during this month. The baby continues to grow and needs more nutrition. The umbilical cord thickens to be able to carry more blood and nutrition. This is also a hazardous period, since any tobacco or drugs may also be transferred to the baby via the same route. The baby is about 7 inches long and has fine hair on her body called ‘lanugo’. A mucus-like substance called the ‘vernix’ begins to cover the baby’s body. The sex of the baby is now easily determined.

The mother’s abdomen begins to bulge and she can feel the baby move. Most women go through a period of emotional elation since the presence of the baby is now unmistakably felt. Since the baby seems to respond to sounds, parents tend to start talking to the baby or playing music in the background. This not only helps to soothe them down, but also lays the foundation of future bonding with their child.

Month 5 – this is a month of rapid growth for the baby. The baby gains maximum length and weight in this month. By the end of the month, she is approximately 30 cm long and weighs almost 400 gm. She becomes very active, moving from side to side and sometimes turning around on her head. The respiratory system starts working and the baby may drink some amniotic fluid. She also begins to urinate.

The mother’s mood may be better during this month as she feels more energetic than during any other month. Her uterus feels heavy and she may have to take rest frequently during the day. There may be leg cramps, especially during the night.

Month 6 – the baby’s skin has an old wrinkled look to it even though fat deposits under the skin start to form. The baby is too young to be born at this time. Most babies born so prematurely do not survive. Only some who do, have to be under intensive care with artificial breathing and precise temperature control in an incubator. The eyes open in this month. Movements become very vigorous and the baby responds perceptibly to sounds.

The mother may start feeling uncomfortable because her belly protrudes. She may experience back pain and may have to make some changes in her posture to balance her weight. Most mothers like to sleep on their backs since turning on the side is very uncomfortable. Though the baby by now has quite a regular sleeping pattern, the mother may still be woken up in the night by a vigorous kick. Appetite is still more than normal. Exercise helps to reduce uncomfortable symptoms like back pain.

The last three months

Month 7 – the baby weighs about two and a half pounds in the beginning of this month and is viable to be born, though still very premature. Finger prints are set and all organs are more or less fully formed. Fingernails form to cover the finger tips. By the end of the month, the weight doubles and the shape of the baby may be felt through the abdomen. The movements of the baby decrease due to its large size, but it can still kick.

The mother may be off balance more often due to the increase in weight. She may feel false contractions called ‘Braxton Hicks’. These should be brought to the doctor’s notice if they are more than five within an hour. The breasts and abdomen may develop stretch marks and may start itching. Massage may help to provide some relief.

Month 8 – the baby is fully formed now and is only undergoing cosmetic changes. The lanugo begins to reduce and the baby changes position to head down, ready to be born. If the baby does not change position, then there may be difficulty during birth. The baby in a position with legs down is called a breach baby.

The mother may feel the urge to urinate frequently. There may be trouble breathing at times when the baby pushes upwards. She may tire easily and may need to rest for longer periods.

Month 9 – the baby is in a perfect condition to be born. The lungs are able to sustain breathing on their own. Fat layers will regulate the baby’s body temperature when she is born. Her immune system is also geared up to fight against infections.

The mother is also psychologically ready to go into labour. The difficulty in breathing may ease due to the baby’s movement downwards. However, urination may increase due to the increased pressure on the bladder. The mother may have to rest very often, and she should not push herself too hard.

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