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What is Pregnancy?

Pregnancy is the period from conception to birth. After the egg is fertilized by a sperm and then implanted in the lining of the uterus, it develops into the placenta and embryo, and later into a fetus. A normal pregnancy usually lasts 40 weeks, beginning from the first day of the woman's last menstrual period (LMP), and is divided into three trimesters, each lasting three months (12-13 weeks).

What are the Stages of pregnancy?

Pregnancy is generally divided into three periods or trimesters, each of about three month's durations. Obstetricians have defined each trimester as lasting for 12-13 weeks, resulting in the average duration of pregnancy as 40 weeks depending upon the women's physiology.

First trimester (from week 1- week 12):

The first 12 weeks of pregnancy are considered as the first trimester. The first trimester is calculated from the first day of LMP although the pregnancy does not actually exist during the first two weeks of pregnancy. These two weeks are the two weeks before conception. Pregnancy starts 2 weeks after the first day of the LMP. Pregnancy officialy lasts 10 months (40 weeks) not 9 months because of these extra weeks.  

The third week is the week in which fertilization occurs and the fourth week is the time when implantation takes place. In the 4th week, the fecundated egg reaches the uterus and burrows into its wall which provides it with the nutrients it needs.  There are hormonal changes that affect every organ system in female body. These changes can trigger symptoms even in the very first weeks of pregnancy. These symptoms include:

  1. Morning Sickness
  2. Extreme tiredness
  3. Tender, swollen breasts. Nipples might also stick out.
  4. Longing or distaste for certain foods
  5. Mood swings
  6. Weight gain or loss
  7. Heartburn
  8. constipation
  9. Increased frequency of urination

Second trimester (week 13- week 28):

Most women feel more energized in this period and begin to put on weight. Also the symptoms like morning sickness and fatigue subside and eventually fade away. The uterus, the muscular organ that holds the developing fetus, can expand up to 20 times its normal size during pregnancy. And before this trimester is over, pregnant woman feels movement of baby.

  1. Stretch marks on abdomen, breasts, thighs, or buttocks
  2. Darkening of the skin around nipples
  3. Body aches, such as back, abdomen, groin, or thigh pain
  4. Swelling of the ankles, fingers, and face
  5. A line on the skin running from belly button to pubic hairline
  6. Patches of darker skin, usually over the cheeks, forehead, nose, or upper lip. Patches often match on both sides of the face. This is sometimes called the mask of pregnancy.
  7. Numb or tingling hands, called carpal tunnel syndrome
  8. Itching on the abdomen, palms, and soles of the feet.(If itching is combined with nausea, vomiting,loss of appetite or jaundice consult your doctor. 

Third trimester (week 29- week 40):

Final weight gain takes place, which is the most weight gain throughout the pregnancy. The fetus grows most rapidly during this stage, gaining up to 28 g per day. The woman's belly transforms in shape as the belly drops due to the fetus turning in a downward position ready for birth.

  1. Shortness of breath
  2. Heartburn
  3. Swelling of the ankles, fingers, and face
  4. Tender breasts, which may leak watery pre-milk called colostrum (kuh-LOSS-struhm)
  5. Belly button may stick out
  6. Trouble sleeping
  7. The baby "dropping", or moving lower in your abdomen
  8. Contractions, which can be a sign of real or false labor
Reference:

http://womenshealth.gov/pregnancy/you-are-pregnant/stages-of-pregnancy.html

What is Prenatal care or Antenatal care?

Prenatal care (also known as antenatal care) refers to the regular medical and nursing care recommended for women during pregnancy. Prenatal care is a form of preventative care with the aim of providing regular health check-ups that allow doctors or midwives to treat and prevent potential health problems throughout the course of the pregnancy while promoting healthy lifestyles that will benefit both mother and child. Prenatal care includes:

  1. Monthly visits to doctor during the first two trimesters (from week 1-28)
  2. Fortnightly visits to doctors from 28th week to 36th week of pregnancy
  3. Weekly visits to the doctor after 36 week (delivery at week 38-40)

Prenatal diagnosis and screening:

Physical examinations generally consist of:

  • Medical history of pregnant mothers
  • Blood pressure of pregnant mothers
  • Height and weight
  • Pelvic exam
  • Doppler fetal heart rate monitoring
  • Blood and urine tests of mother
  • Discussion with caregiver

As per government of India norms: Every pregnant women makes at least  four visit for ANC, including the registration or the first visit.

Suggested schedules for antenatal visits:

1st visit: Within 12 weeks or preferably as soon as pregnancy is suspected.

2nd visit: Between 14 and 26 weeks

3rd visit: Between 28 and 34 weeks

4th visit: Between 36 weeks and term.

Ultrasound: Obstetric ultrasounds are most commonly performed during the second trimester at approximately week 20. Ultrasounds are considered relatively safe and have been used for over 35 years for monitoring pregnancy. Among other things, ultrasounds are used to:

  • Check for multiple fetuses
  • Assess possible risks to the mother (e.g., miscarriage, blighted ovum, ectopic pregnancy, or a molar pregnancy condition)
  • Check for fetal malformation (e.g., club foot, spina bifida, cleft palate, clenched fists)
  • Determine if an intrauterine growth retardation condition exists
  • Note the development of fetal body parts (e.g., heart, brain, liver, stomach, skull, other bones)
  • Check the amniotic fluid and umbilical cord for possible problems
  • Determine due date (based on measurements and relative developmental progress)

Generally an ultrasound is ordered whenever an abnormality is suspected or along a schedule similar to the following:

  • 7 weeks - confirm pregnancy, ensure that it's neither molar or ectopic, determine due date
  • 13-14 weeks - evaluate the possibility of Down Syndrome
  • 18-20 weeks
  • 34 weeks  - evaluate size, verify placental position

http://www.nlm.nih.gov/medlineplus/ency/article/003778.htm
Guidelines for Antenatal care at Birth

Counselling

The woman should be counseled on the issues mentioned below:

  1. Help the woman to plan and prepare for birth (birth preparedness/micro birth plan).
  2. This should include deciding on the place of delivery and the presence of an attendant at the time of the delivery.
  3. Advantages of institutional deliveries and risks involved in home deliveries should be explained.
  4. Advise the woman on where to go if an emergency arises, and how to arrange for transportation, money and blood donors in case of an emergency.
  5. Educate the woman and her family members on signs of labour and danger signs of obstetric complications.
  6. Emphasize the importance of seeking ANC and PNC.
  7. Advise on diet (nutrition) and rest.
  8. Inform the woman about breastfeeding, including exclusive breastfeeding.
  9. Provide information on sex during pregnancy.
  10. Warn against domestic violence (explain the consequences of violence on a pregnant woman and her foetus).
  11. Promote family planning.

Advantages of institutional deliveries

All pregnant women must be encouraged to opt for an institutional delivery.

Women should be explained why delivery at a health facility is recommended and emphasized as:

  1. Complications can develop at any time during pregnancy, during delivery or in the postnatal period. These complications are not always predictable. If they are not handled by professionals at the health facility, they can cost the mother and/or the baby their life.
  2. Since a health facility has staff , equipment, supplies and drugs, it can provide the best care. It also has a referral system should the need for referral arise.

Abdominal pain during pregnancy?

Occasional abdominal discomfort is quite common during pregnancy and it may be harmless. Severe or persistent abdominal pain should never be ignored.

If a pregnant women experience abdominal pain or cramping along with spotting, bleeding, fever, chills, vaginal discharge, faintness, discomfort while urinating or if the pain doesn't subside after several minutes of rest, then seek for medical help.

What are the serious problems that can lead to abdominal pain during pregnancy?

 Ectopic pregnancy

An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, in general in one of the fallopian tubes. It may cause some cramping and other symptoms in early pregnancy.

An ectopic pregnancy can be life-threatening if left untreated. Seek medical attention immediately if you have any of the following symptoms:

  1. Abdominal or pelvic pain or tenderness,
  2. vaginal spotting or bleeding (can be red or brown, copious or scant, continuous or intermittent), Pain that gets worse during physical activity or while moving your bowels or coughing
  3. Pain in your shoulder.

Miscarriage/Early pregnancy loss

Miscarriage is the loss of a pregnancy in the first 20 weeks. Vaginal spotting or bleeding is generally the first symptom, followed by abdominal pain a few hours to a few days later.

The bleeding may be light or heavy. The pain may feel crampy or persistent, mild or sharp, and may feel more like low back pain or pelvic pressure.

Premature labor

Premature labor (also known as preterm labor) is the contractions that are started before 37th weeks of pregnancy.

Placental abruption

Placental abruption is a life-threatening condition in which your placenta separates from uterus, partially or completely, before baby's birth

There's wide variation in symptoms. A placental abruption can sometimes cause sudden and obvious bleeding, but in other cases there may not be any noticeable bleeding at first, or might have only light bleeding or spotting.

Urinary tract infections

During pregnancy a women is more susceptible to urinary tract infections of all kinds, including kidney infections.

Symptoms of a bladder infection may include pain, discomfort, or burning while urinating; pelvic discomfort or lower abdominal pain (often just above the pubic bone); a frequent or uncontrollable urge to urinate, even when there's very little urine in the bladder; and cloudy, foul-smelling, or bloody urine

Other causes

Many other conditions can also cause abdominal pain. Some of the most common causes of abdominal pain that your practitioner might consider are a stomach virus, food poisoning, appendicitis, kidney stones, hepatitis, gallbladder disease, pancreatitis, fibroids, and bowel obstruction.

Breastfeeding

Pregnancy is the ideal time to counsel the mother on the benefits of breastfeeding her baby.Though breastfeeding is almost universal in India, the following key messages need to be given to the would-be mother:

The mother should be breastfed ideally and should be initiated immediately after birth, preferably within one hour, even if the birth has been by caesarean section.

Is doing Physical activity, essential during pregnancy?

Fitness goes hand in hand with right kind of eating behaviors to maintain physical health and well-being during pregnancy. Healthy pregnant women should do at least 2 hours and 30 minutes of moderate-intensity aerobic activity a week.

Special benefits of physical activity during pregnancy:

Exercise can ease and prevent aches and pains of pregnancy including constipation, varicose veins, backaches, and exhaustion.
Active women seem to be better prepared for labor and delivery and recover more quickly.
Exercise may lower the risk of preeclampsia and gestational diabetes during pregnancy.
Fit women have an easier time getting back to a healthy weight after delivery.
Regular exercise may improve sleep during pregnancy.
Staying active can protect your emotional health. Pregnant women who exercise seem to have better self-esteem and a lower risk of depression and anxiety.
Keep these points in mind when choosing a fitness plan:

  • Avoid activities in which you can get hit in the abdomen like kickboxing, soccer, basketball, or ice hockey.
  • Steer clear of activities in which you can fall like horseback riding, downhill skiing, and gymnastics.

http://womenshealth.gov/pregnancy/you-are-pregnant/staying-healthy-safe.html

Tips for safe and healthy physical activity

Follow these tips for safe and healthy fitness:

  1. During exercises, start slowly, progress gradually, and cool down slowly.
  2. You should be able to talk while exercising. If not, you may be overdoing it.
  3. Take frequent breaks.
  4. Don't exercise on your back after the first trimester. This can put too much pressure on an important vein and limit blood flow to the baby.
  5. Avoid jerky, bouncing, and high-impact movements. Connective tissues stretch much more easily during pregnancy. So these types of movements put you at risk of joint injury.
  6. Be careful not to lose your balance. As your baby grows, your center of gravity shifts making you more prone to falls. For this reason, activities like jogging, using a bicycle, or playing racquet sports might be riskier as you near the third trimester.
  7. Don't exercise at high altitudes (more than 6,000 feet). It can prevent your baby from getting enough oxygen.
  8. Make sure you drink lots of fluids before, during, and after exercising.
  9. Do not work out in extreme heat or humidity.
  10. If you feel uncomfortable, short of breath, or tired, take a break and take it easier when you exercise again.

Stop exercising and call your doctor as soon as possible if you have any of the following:

  1. Dizziness
  2. Headache
  3. Chest pain
  4. Calf pain or swelling
  5. Abdominal pain
  6. Blurred vision
  7. Fluid leaking from the vagina
  8. Vaginal bleeding
  9. Less fetal movement
  10. Contractions

http://womenshealth.gov/pregnancy/you-are-pregnant/staying-healthy-safe.html

Work out your pelvic floor (Kegel Exercises)

Your pelvic floor muscles support the rectum, vagina, and urethra in the pelvis. Toning these muscles with Kegel exercises will help you push during delivery and recover from birth. It also will help control bladder leakage and lower your chance of getting hemorrhoids.

Pelvic muscles are the same ones used to stop the flow of urine. Still, it can be hard to find the right muscles to squeeze. You can be sure you are exercising the right muscles if when you squeeze them you stop urinating. Or you can put a finger into the vagina and squeeze. If you feel pressure around the finger, you've found the pelvic floor muscles. Try not to tighten your stomach, legs, or other muscles.

What is kegel exercises?

  1. Tighten the pelvic floor muscles for a count of three, then relax for a count of three.
  2. Repeat 10 to 15 times, three times a day.
  3. Start Kegel exercises lying down. This is the easiest position. When your muscles get stronger, you can do Kegel exercises sitting or standing as you like.
References:

http://www.nlm.nih.gov/medlineplus/ency/article/003975.htm

What are risks factors in pregnancy?

Environmental risks

The environment is everything around us wherever we are at home, at work, or outdoors. Although you don't need to worry about every little thing you breathe in or eat, it's smart to avoid exposure to substances that might put your pregnancy or unborn baby's health at risk.

During pregnancy, avoid exposure to:

  1. Lead - found in some water and paints, mainly in homes built before 1978
  2. Mercury - the harmful form is found mainly in large, predatory fish.
  3. Arsenic - high levels can be found in some well water
  4. Pesticides - both household products and agricultural pesticides
  5. Solvents - such as degreasers and paint strippers and thinners
  6. Cigarette smoke

As there is uncertainty in how much exposure can lead to problems, such as miscarriage or birth defects. The best way is to avoid or limit the exposure as much as possible. Here are some simple, day-to-day precautions:

  • Clean in only well-ventilated spaces. Open the windows or turn on a fan.
  • Check product labels for warnings for pregnant women and follow instructions for safe use.
  • Do not clean the inside of an oven while pregnant.
  • Leave the house if paint is being used, and don't return until the fumes are gone.

If exposed to chemicals in the workplace, talk to doctor and employer about what can do tolower your exposure. Certain industries, such as dry cleaning, manufacturing, printing, and agriculture, involve use of toxins that can be harmful.

Quit smoking

Smoking cigarettes is very harmful to health and could also affect the health of baby. Not only does smoking cause cancer and heart disease in people who smoke, smoking during pregnancy increases the risk of low birth weight. Low birth weight babies are at higher risk of health problems shortly after birth. Women who smoke during pregnancy are more likely than other women to have a miscarriage and to have a baby born with cleft lip or palate, types of birth defects. Also, mothers who smoke during or after pregnancy put their babies at greater risk of sudden infant death syndrome (SIDS).

Substance abuse

Using alcohol and illegal drugs during pregnancy threatens the health of unborn baby. So does using legal drugs in an inappropriate way. When to use alcohol or drugs, the chemicals you ingest or breathe into your lungs cross the placenta and enter your baby. This can put the baby at risk for such problems as stillbirth, low birth weight, birth defects, behavioral problems, and developmental delays.

Alcohol

If a pregnant mother drink alcohol, so does baby. Pregnant women should not drink alcohol to eliminate the chance of giving birth to a baby with fetal alcohol spectrum disorder (FASD). FASD involves a range of harmful effects that can occur when a fetus is exposed to alcohol. The effects can be mild to severe. Children born with a severe form of FASD can have abnormal facial features, severe learning disabilities, behavioral problems, and other problems.

Pesticides exposure during pregnancy

Pesticide is a substance or mixture of substances designed for preventing, destroying, repelling or lessening the damage of a pest (unwanted plants, animals, insects, germs or other organisms that interfere with human activity). They include insecticides, rodenticides, herbicides, fungicides, fumigants etc. Pesticides may be made of chemical substances or biological agents.

Use of chemical substances (pesticide) is the important element in integrated vector management for prevention and control of major vector-borne diseases such as malaria, dengue and in case of vector born epidemics they constitute first line of action. Their improper and inappropriate uses can trigger adverse and chronic effects on humans and the environment.

Common classes of chemical pesticides are organochlorines (DDT, Dieldrin,) organophosphates (malathion, glyphosate), carbamates(aldicarb), pyrethroids (permethrin), triazines, and neonicotinoids. All chemicals including natural chemicals, have potential to harm if they are not properly handled. The government has banned some pesticides while the use of others has been regulated.

Maternal exposure to certain pesticides during pregnancy may increase the risk of having a fetus or neonate affected by congenital anomalies. Women should reduce or eliminate environmental exposure to hazardous substances (such as heavy metals or pesticides) during pregnancy.

How can pregnant women expose to pesticides?

Pregnant women can expose to pesticides in several ways by:

  • inhaling them when breathing,
  • ingesting them by eating foods that were sprayed with pesticides,
  • absorbing them through skin.

Pesticides may be a part of everyday life that include:  

  • Air and water- When outdoor pesticides are being sprayed, wind can carry some of the pesticide to other areas. Small amounts of outdoor pesticides can also be found in the food and water supply.
  • Food (pesticides used on food crops to protect them from insects)
  • Expectant mothers living near crops
  • Grass in public places like parks, may be treated with pesticides
  • Pet products, like flea and tick shampoo
  • Rodent poisons
  • Cleaning products

What problems can pesticides cause during pregnancy?

Exposure to large amounts of pesticides like those used on crops may be harmful to the baby during pregnancy. It may lead to:

  • Birth defects-During the first semester of pregnancy the nervous system of foetus is rapidly developing therefore toxic substance are harmful in early weeks of pregnancy.
  • Learning problems later in child’s life
  • Low birth weight (less than 2500gms)
  • Miscarriage/abortion (termination of pregnancy before 20 weeks of pregnancy) 
  • Premature birth (child birth before 37 weeks of pregnancy) 

The best plan is to avoid using pesticides or insecticides in home, on pests, or in the garden during pregnancy, especially avoid them during first trimester when the baby’s neural tube and nervous system are developing.

Pregnant women can minimize exposure to pesticides by:

  • Washing hands before eating;
  • thoroughly washing and scrubbing all fruits and vegetables under running water;
  • peeling fruits and vegetables;
  • eating organic foods (foods are grown without the use of pesticides);
  • eating fresh seasonal fruits and vegetables;
  • trimming fat from meat and skin from poultry (such as chicken, turkey) and fish;
  • avoiding exposure to agriculture area where pesticides are used.

Precautions advised during pest control measures taken inside the home:

  • Use something other than chemicals, like mousetraps or sticky traps, instead of pesticides. (Be careful not to set traps in places where children can get to them). 
  • Ask someone else to apply the pesticide in your home.
  • Read the instructions and warnings on product labels for pesticides and follow them.
  • Leave the area for the amount of time indicated on the pesticide package.
  • Remove food, dishes and utensils from the area before using a pesticide. 
  • Wash all surfaces where food is normally prepared following application of pesticides in the home.
  • Open the windows to air out your home after using the pesticide.  

Precautions advised during pest control measures taken outside in the yard/garden:

  • Treat pest problems in your yard or garden with something other than chemicals. If pesticides are used, treat specific places affected by pests or weeds and don’t spray whole lawn or garden.
  • Don’t spray pesticides outside on a rainy or windy day. They can blow or run into places, like swimming pools or vegetable gardens.
  • Read the instructions and warnings on product labels for all pesticides.
  • Close all the windows in your home and turn off the air conditioning. This helps keep pesticides in the air from coming inside.
  • Wear rubber gloves when gardening to avoid touching pesticides. 
  • If possible, pregnant women should avoid mixing and applying pesticides herself. If not possible, exposure can be minimized by working in a well-ventilated area and using protective equipment such as a respirator(mask), long sleeves and pants, and gloves.
  • Always follow handling and storage instructions on the pesticide label.

Protection from pesticides during pregnancy at work:

  • If pregnant woman works with pesticides, she should talk to authorities and may change job responsibilities.
  • Wear protective clothing. Shower and change your clothes (including shoes) before going home.
  • Wash your work clothes at work or wash them at home separately from the rest of the laundry.

Are insect repellents safe to use during pregnancy?

Insect repellants are products used to keep insects away, like mosquitoes and ticks. Insect repellants are safe to use during pregnancy. Follow the directions on the product label.

Other ways to prevent insect bites include:

  • Staying indoors in the early morning or late afternoon when mosquitoes are most likely to bite
  • Wearing long pants and long sleeves when going outdoors
  • Incorporate integrated vector management (IVM) to prevent from insect bites.

References

archive.india.gov.in/citizen/agriculture/index.php?id=25

www.marchofdimes.org/pregnancy/pesticides-and-pregnancy.aspx

mothertobaby.org/fact-sheets/pesticides-pregnancy/pdf/

americanpregnancy.org/pregnancy-health/pesticides/

When to call the doctor?

When you are pregnant, do not hesitate to call the doctor or midwife if something is bothering or worrying you. Sometimes physical changes can be signs of a problem.

Call your doctor or midwife as soon as you can if you:

  • Are bleeding or leaking fluid from the vagina
  • Have sudden or severe swelling in the face, hands, or fingers
  • Get severe or long-lasting headaches
  • Have discomfort, pain, or cramping in the lower abdomen
  • Have a fever or chills
  • Are vomiting or have persistent nausea
  • Feel discomfort, pain, or burning with urination
  • Have problems seeing or blurred vision
  • Feel dizzy

Suspect your baby is moving less than normal after 28 weeks of pregnancy (if you count less than 10 movements within 2 hours).

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External Links/References