VIII. PREGNANCY
A. PREGNANCY TESTS
What are pregnancy tests and how do they work?
Pregnancy tests look for a special hormone in the urine or blood that is only there when a woman is pregnant. This hormone, human chorionic gonadotropin (hCG), can also be called the pregnancy hormone. The pregnancy hormone, hCG, is made in your body when a fertilized egg gets attached to the uterus. This usually happens about 6 days after conception
What are Home Pregnancy tests (HPTs)?
Home Pregnancy tests are do-it-yourself tests which can be conveniently done at home. They are easily available over the counter and cost approximately between 45-50 rupees. A woman is supposed to collect just about 5 ml of her urine in a clean container and perform the test using put one to two drops of the urine into a special container provided in the kit. Then the woman needs to wait a few minutes. Different brands instruct the woman to wait different amounts of time. Once the time has passed, the user should inspect the "result window." If a line or plus symbol appears, you are pregnant. It does not matter how faint the line is. A line, whether bold or faint, means the result is positive.
How soon after a missed period can I take a home pregnancy test and get accurate results?
Many home pregnancy tests (HPTs) claim to be 99% accurate on the day you miss your period.
If one gets a negative result on a home pregnancy test can she still be pregnant?
Yes. So, most HPTs suggest women take the test again in a few days or a week
B.EARLY PREGNANCY:FIRST TRIMESTER
What are the early symptoms of pregnancy?
Most women equate a missed menstrual period with the possibility of being pregnant, but other symptoms and signs are experienced by most women in the early stages of pregnancy. These include: (i) Feelings of breast swelling, tenderness, or pain (ii) Nausea and vomiting traditionally associated with morning sickness (iii) Frequent urination. (iv) Fatigue and tiredness (vi) Food aversions or cravings (vii) mood swings (viii) deepening of the colour of the area around the nipple (ix) Pigmentation of the face
Is a missed menstrual period always the first sign of pregnancy?
A missed menstrual period is most often the first sign of pregnancy, although a woman may still experience some bleeding or spotting around the time of the expected period. However, if a woman does not have regular menstrual cycles, she may notice some of the other symptoms of early pregnancy before it is apparent that the menstrual period has been missed.
How can one determine the due date of delivery ?
A pregnancy generally lasts for 40 weeks from first day of your last menstrual period, If you know the date of your last menstrual period, and your cycles are regular, you should be able to determine your due date sitting at home. Based on LMP : If your cycles are regular and 28 days long, then you can determine your due date by adding 9 months and 7 days to the first day of your last menstrual period (LMP). For example, if your LMP began on September 5, then your expected due date (EDD) would be June 12 of the following year.
Does nausea and vomiting always occur in the morning during early pregnancy?
The nausea and vomiting associated with early pregnancy can occur at any time of the day or night.
How could one cope with the nausea and vomiting associated with pregnancy?
Try some of these tips to help prevent and soothe nausea: (i) Eat frequent, small meals (
Should a doctor be consulted for nausea and vomiting?
A doctor should be consulted if you think that you are vomiting too much. Excessive vomiting can lead to dehydration for which hospitalization may be required.
Why does frequent urination occur in pregnancy?
Early in pregnancy, the growing uterus presses on your bladder. This causes frequent urination.
C.SECOND TRIMESTER
What are the signs and symptoms of the second trimester of pregnancy?
During the second trimester: (i)Nausea/vomiting and fatigue become less (ii) Abdominal expansion (iii) Weight gain (iv) Backache (v) Stretch marks on the abdomen (vi) Skin pigmentation on the face.
D.THIRD TRIMESTER
What are the signs and symptoms of the second trimester of pregnancy ?
During the third trimester, the following signs and symptoms are manifested (i) Breathing becomes more difficult due to pressure by the growing baby (ii) Frequent urination (iii) Burning pain in the chest (iv) constipation (v) Swollen tender breasts (vi) Trouble sleeping. (vii)Abdominal contractions
What is premature labour?
Pre mature labour is referred to as onset of delivery before the 37th week.
What are the symptoms of premature labour ?
The symptoms of pre mature labour include: (i) Pain or pressure in the lower back (ii) Pressure in the thighs (iii) A vaginal discharge that is watery, pinkish and brownish (iv) Menstrual-like cramps, nausea, diarrhoea or indigestion (v) A rupture of membranes in your vagina.
Why do abdominal contractions occur?
Abdominal contractions are painless which start as early as the 10th week but are clearly appreciated in the last trimester. When these contractions become more frequent & intense , they could even be mistaken for the beginning of real labour.
E. ALARMING SIGNS
Which are the symptoms which can indicate danger in pregnancy?
The following symptoms may be signs of a serious condition : (i) Vaginal bleeding or spotting.(ii) Sudden weight gain (iii) persistent headache (iv) blurred vision (v) sudden swelling of hands/ feet. (vi) Prolonged vomiting (vii) High fever with chills (viii) Sudden intense abdominal pain in early pregnancy (ix) Inability to appreciate foetal movements.
What does vaginal bleeding or spotting indicate?
Vaginal bleeding or spotting in the early months accompanied by abdominal pain may be a warning sign of a possible abortion. Vaginal bleeding in the later months may indicate a low lying placenta or separation of placenta from the uterine wall.
What do sudden weight gain, persistent headache , blurred vision , sudden swelling of hands/ feet indicate?
These symptoms may indicate high blood pressure in pregnancy, a condition also known as toxemia. A woman with these symptoms may need to be hospitalized to bring down her blood pressure or for fetal testing. Toxemia could result in complications like inadequate fetal growth, premature labour or fetal distress during labour.
Why is high fever dangerous in pregnancy?
High fever accompanied with chills and without symptoms of cold may be indicative of an inflammation of the membranes around the foetus, known as amnionitis. This can be potentially dangerous for the foetus and result in pre mature labour.
F. ROUTINE TESTS
What diseases are regularly tested for even during a normal pregnancy ?
Some of the conditions routinely checked for in most normal pregnancies are AIDS, Hepatitis B, Syphilis, Rh Incompatibility and Rubella. The doctor can test for all these condition with blood samples, taken at different times in the pregnancy.
When should one be worried about congenital diseases ?
Your baby has a higher chance of having congenital disease if he falls in any of the three reasons: (i) Congenital diseases in the previous baby (ii) History of congenital anomalies in the family which are likely to be repeated (iii) Maternal age is above 35, then there is a higher chance of the baby getting Down's syndrome .
Can birth defects be detected with regular blood tests ?
Studies have shown that 90 % of birth defects cannot be detected through prenatal blood tests. In order to isolate the remaining 10 % of the identifiable birth defects, there are four main types of tests: amniocentesis, chorionic villi sampling, certain blood tests like the Alpha feto-Protein (AFP) test, and ultrasound scans.
G. GENERAL CARE
Why is so much stress laid on a healthy diet?
As you are the only source of nutrition for your unborn baby, your eating habits will affect your baby's health and well-being. In order to cope with the increased demands, your body needs a sufficient amount of nutrition
How many calories does an expectant mother require ?
A. In the early months of pregnancy, you do not need to change your diet. However, as the pregnancy advances, you may need to increase your calorific intake to 300 additional calories a day. This normally happens in the second and third trimesters. If you eat more than this amount, it is you who will gain the unnecessary weight, and not your baby. So make sure that you avoid junk foods like burgers, fries, cookies, etc. as these constitute empty calories. What you need is a sufficient amount of proteins, carbohydrates and foods that contain minerals and vitamins such as chappatis, pulses, soy, milk, eggs, non veg foods, nuts, green leafy vegetables and fresh fruits.
They say that a pregnant woman eats for two ?
Your pregnancy does not entitle you to eat for two. In fact, if you do eat for two, you will gain so much weight that you will not only be inviting unnecessary complications, but will also have difficulty in shedding your excess weight after pregnancy.
What is a balanced diet for a pregnant woman?
During pregnancy, your diet should consist of the following
3 helpings of first class proteins –egg, soyabean, non-veg item
2 helpings of vitamin C foods –citrus fruits/ tomatoes
4 helpings of calcium-rich foods (4 during pregnancy, and 5 during lactation) –milk, curd
3 helpings of green, leafy and yellow vegetables or fruits –spinach, bathua, cholai, pumpkin, papaya, carrot
½ serving of other fruits and vegetables –brinjal, bottleguard, cabbage.
4-5 helpings of whole grain and complex carbohydrates –chappatis, rice.
8-10 glasses of water
Dietary supplements based on your doctor's recommendation
Which dietary supplements does a pregnant woman need to take ?
A pregnant woman requires vitamins, iron and calcium in her diet. Iron-folic acid tablets and Calcium tablets are available free of cost at all government health centers. These supplements are also available over the counter. A doctor should be consulted for prescribing these dietary supplements.
What is the ideal weight gain for a healthy pregnancy ?
A woman should gain anywhere between 11-14 kg on average.
What is the optimum trimester wise weight gain?
The optimum trimester wise weight gain is as follows: (i)First trimester: 1-2 kg (ii) Second trimester: 5-7 kg (iii) 4-5 kg
Is it safe to drink tea/coffee or fizzy drinks during pregnancy?
Consumption of tea, coffee and fizzy drinks should be limited during pregnancy.
How can one cope with craving for foods that are less nutritious?
If you have a craving for something unhealthy, first try to distract yourself or find a healthy alternative. If it still persists, you may give in just a little bit but whatever you do, do not compromise upon your baby's nutritional needs
What is one supposed to do if there is a bizarre craving for peculiar non edible items?
A doctor should be consulted as this may be a sign of an underlying nutritional disorder.
How can constipation be relieved during pregnancy?
As many as half of all pregnant women have problems with constipation. General Some treatment measures include: (i) Drink at least 8 glasses of water each day, including 1-2 glasses of fruit juice (ii) Include bulk foods, foods high in fiber, such as cereals, and raw fruits and vegetables. (iii) Exercise daily-walking is a good form of exercise. Exercise and good physical fitness helps to maintain healthy bowel patterns. (iv) For occasional constipation, you may use a stool softener laxative as prescribed by your doctor.
Is it normal for gums to swell and/or bleed during pregnancy?
The extra hormones in the body during pregnancy may cause the gums to swell and bleed. Brush regularly, using a soft toothbrush. Having a dental checkup early in pregnancy is a good idea to be sure your mouth is healthy.
What can be done to prevent burning pain in the chest?
To prevent burning pain in the chest: (i) Eat small frequent meals, 5 or 6 per day instead of 2 or 3 large meals. Avoid drinking large amounts of fluids with meals. (ii) Avoid foods that cause gas and spicy or greasy foods. (iii) Do not eat or drink before bedtime. (iv) Wait 2 hours after eating before exercising. (v) No alcohol or smoking. (vi) Avoid very hot or very cold fluids.
Is it safe to continue to have sexual intercourse during pregnancy?
Some couples worry about having intercourse during pregnancy. They may be afraid that it will cause a miscarriage. For a healthy woman with a normal pregnancy, intercourse is safe into the last weeks of pregnancy. You and your partner may want to experiment with different positions that may be more comfortable for you.
Are leg cramps common in pregnancy?
Yes, you may find that you have an increase in leg cramps in the second and third trimesters of pregnancy. Get plenty of calcium (three glasses of milk or supplement) and potassium (bananas and oranges). Stretching your legs before going to bed may help relieve cramps.
May one travel during pregnancy?
Most women can travel safely until close to their due date. Frequently, the most comfortable time to travel is in the middle of pregnancy. Problems are least likely to happen during this time.
Why should one exercise during pregnancy ?
The exercises are aimed at the following: (i) Improving posture and appearance (ii) Relieving back pain (iii) Strengthening muscles for delivery and for supporting loosened joints (iv) Relieving muscle cramps (v) Enhancing circulation (vi) Increasing flexibility (vii) Increasing energy level by combating fatigue (viii)Promoting feelings of well-being and developing a positive self image .Your doctor will advice you about the right kind of exercise.
Will exercise benefit my baby ?
Yes. Exercise is extremely good for the foetus because it causes blood flow to increase and improve the baby's growth and development. Exercise also makes the baby's brain and other tissues start functioning in optimum condition.
What kind of exercise is safe during pregnancy?
Continuing any sport or mild form of exercise should not be a problem, as long as it is done in moderation. However you must first consult your doctor
What kind of exercises should one totally avoid ?
Exercises like jogging is very hard on the spine, pelvis, hips, knees, breasts and back and should be avoided. Exercises that pull your abdominal muscles, like leg lifts and sit-ups, are also not advisable during pregnancy. Further, do not try your hand at any new sport once you get pregnant; your body needs time to adjust to new movements. After the 4th month, do not exercise while lying flat on your back, as the weight of your uterus can compress major blood vessels, and restrict circulation.
How long can I continue working after I am pregnant?
Pregnant women who have no complications can continue working until the ninth month. They must however, take certain precautions such as avoiding strenuous activity, stair-climbing, extreme temperatures and smoky areas. They must also take frequent breaks and leave early if they are feeling exhausted. If they have been standing for a prolonged period, they should sit down and put their feet up. Standing for extended periods, lifting heavy objects, stooping and bending should be avoided in the last three months. Pregnant women must eat regular meals. A sedentary job that is not particularly stressful may be less of a strain than staying at home.
What relaxation techniques are helpful during pregnancy ?
The following techniques are helpful in pregnancy: (i) Lie on your back with your head on the cushion and your lower legs raised on a chair. Close your eyes and relax for 10-15 minutes. This exercise will also help relieve swollen ankles and feet. (ii) Lie on your side and keep a pillow underneath your head.
Why do doctors recommend that a pregnant woman should sleep on her left side?
Although sleeping on the back may be more comfortable to start with, it leads to backaches and haemorrhoids, and inhibits digestion, breathing and circulation .This is because the entire weight of the uterus on the back. Whereas, stretching out on your left side, allows maximum flow of blood and nutrients to the placenta, enhances the functioning of the kidneys, which leads to better elimination of waste materials (which in turn would cause swelling ). So this should be, technically, the most comfortable position.
H. HIV AND PREGNANCY
If the mother is HIV positive , what are the chances for the baby to become HIV positive?
There are 25 % chances that the baby will become HIV positive.
What are the options available to an HIV positive mother to reduce the chances of transmission of infection to her baby?
Women with HIV should receive during pregnancy whatever antiviral chemotherapy is recommended according to current adult guidelines. Then in addition, they should receive intravenous therapy with an antiviral starting about 3 hours before and then during the Cesarean delivery. The baby will then receive oral antiviral syrup for the first 6 weeks of life. Right now this is the best therapy for minimizing HIV infection in the newborn. Delivery by caesarean section is also advised.
What are the chances of infection to the infant if the women is on anti viral therapy and undergoes C- section?
When Anti viral therapy is given to a woman during pregnancy, the incidence of infection is reduced to about 5-8%. When C-section is performed and antiviral therapy is given during labor, the infection rate is further reduced to about 2%.
I. LABOUR
What is labour?
Labour can be said to be a series of events that take place in different organs in an effort to expel a live baby out of uterus through the vagina into the outer world.
What is pre term labour?
Pre term labour occurs before 37 weeks of pregnancy.
What is Caesarean Section?
Caesarean section (C-section) is the delivery of a baby through a cut in the mother’s lower abdomen and the uterus.
What are the conditions for which a planned caesarean section is done?
Following are the conditions for which a planned caesarean section is done
Previous 2 or more caesareans.
Low lying placenta
Mal-presentations of your baby .
Small pelvis
Underlying conditions like Pregnancy induced Hypertension, diabetes.
For the conditions for which an emergency caesarean section is done?
Following are the conditions for which an emergency caesarean section is done :
Distress of the foetus: Your baby may not be tolerating the forces of labour well, and may show problems like irregularity or slowing of the heart rate, or acid in the blood. Sometimes greenish discolouration of the amniotic fluid (passage of meconium or foetal stools in utero) may be a sign of distress. If vaginal delivery cannot be completed quickly, a caesarean may be the best way to save your baby.
Non-progress of labour
Bleeding from the placenta
J. BREAST FEEDING RELATED CONCERNS
How long after delivery must breastfeeding be initiated?
Breastfeeding may be initiated at least half an hour following normal delivery and 4 hours following caesarean section.
How often should one breastfeed?
Daytime every two to three hours for at least 10-15 minutes on each breast. You may need to wake your baby (a diaper change and holding baby upright and talking to baby helps waken baby) during the day so your nights will be more restful. As baby's nutritional needs are better met during the day, baby will not wake as often during the night. Sometimes your breasts will be full during the night and baby may still be asleep so you will want to wake your baby and nurse. As baby gets older, feedings will space out.
How can breast engorgement be prevented?
Breast engorgement can be prevented by increasing the frequency of breast feeding such as every one and a half to 2 hours till the engorgement subsides.
How can I tell if my baby is getting enough milk?
If your baby has four to six wet diapers in a 24-hour period, it means that you are supplying the baby with a good amount of breast milk. Another sign that there is good milk transfer is your breasts soften with nursing.
Does baby get anything before milk comes in?
Yes, your breasts supply colostrum, a very concentrated milk full of antibodies. This colostrum acts as a laxative, helping clear meconium (black tarry stool) and bilirubin (which may make baby jaundiced or yellow) from your baby.
What is post partum breast infection and what is its cause?
Post partum breast infection occurs when bacteria lodged on the nipple get into a breast through a crack on the nipple or through a duct when breastfeeding.
What are the symptoms of post partum breast infection?
It is characterized by pain and swelling of the breasts, redness of the overlying skin and may/ may not be associated with fever.
What is to be done in case of a post partum breast infection?
Breastfeeding should be continued and a doctor should be consulted for prescription of antibiotics.
What happens if prompt treatment is not sought?
If prompt treatment is not sought, it may lead to development of a breast abscess.
What causes sore nipples?
When you are first learning to breastfeed, sore nipples are the result of poor positioning.
How can sore nipples be managed?
Sore nipples can be managed by Properly position baby's gums over the center of the nipple where the milk is pooling, not the tip of the nipple where you have lots of nerve endings
Why does the baby get suddenly hungry?
Babies have growth spurts, usually between 1-2 weeks old, at 6 weeks old, and 3 months old. Baby may want to nurse twice as often for 1-2 days during that time, and this extra stimulation will automatically increase mother's supply to match baby's demands.
What causes breast lumps during nursing and how can it be managed?
Lumpy breasts can be normal when nursing and is caused due to a plugged duct. Before nursing, use heat (warm shower or warm compress) and breast massage (gentle circular motion with fingertips from chest wall, over lump towards nipple) then nurse or pump. It is important to clear a plugged duct because it can lead to a breast infection. If the lump doesn't clear with this treatment or you develop flu-like symptoms, call the doctor.
K. OTHER POST PARTUM RELATED CONCERNS
How long will the perineal pain from delivery last so I can know how long before I can resume intercourse?
In general, you should expect that it takes about month before perineal discomfort with walking or sitting goes away but it may easily take 2 months. Also it will take about 3 months before the discomfort with vaginal intercourse goes away but it may be 6 months or more.
What causes pain with urination, frequency, vulvar burning after delivery ?
The hormones of pregnancy, high estrogen and progesterone, decline rapidly after delivery resulting in dryness of the vagina and inner mucosal lining of the vulva. As a result, it becomes sensitive to any irritation from soaps, rubbing, or contact with chemicals in pads, condoms, lotions or other topically applied agents.
Do women suffer from uncontrolled passing of gas or even stool from the anus after delivery.?
After vaginal delivery, some women do have difficulty holding their stool or gas. It occurs much more commonly after injury to the anal sphincter muscle, even if that injury is surgically repaired at the time of delivery
What can be done about the vaginal opening looseness or pelvic prolapse after delivery ?
For this, a doctor/physiotherapist should be consulted who will advice about Kegels exercise to reduce the muscle tone.
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