Pregnancy is 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. Pregnancy usually lasts 40 weeks, beginning from the first day of the woman's last menstrual period, and is divided into three trimesters, each lasting three months.
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 weeks, resulting in the average duration of pregnancy is 40 week 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 as the first two weeks of pregnancy although the pregnancy does not actually exist. These two weeks are the two weeks before conception and include the woman's last period.
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:
- Morning Sickness
- Extreme tiredness
- Tender, swollen breasts. Nipples might also stick out.
- Longing or distaste for certain foods
- Mood swings
- Weight gain or loss
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 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.
- Stretch marks on abdomen, breasts, thighs, or buttocks
- Darkening of the skin around nipples
- Body aches, such as back, abdomen, groin, or thigh pain
- Swelling of the ankles, fingers, and face
- A line on the skin running from belly button to pubic hairline
- 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.
- Numb or tingling hands, called carpal tunnel syndrome
- Itching on the abdomen, palms, and soles of the feet.
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.
- Shortness of breath
- Swelling of the ankles, fingers, and face
- Tender breasts, which may leak watery pre-milk called colostrum (kuh-LOSS-struhm)
- Belly button may stick out
- Trouble sleeping
- The baby "dropping", or moving lower in your abdomen
- Contractions, which can be a sign of real or false labor
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:
- Monthly visits to doctor during the first two trimesters (from week 1-28)
- Fortnightly visits to doctors from 28th week to 36th week of pregnancy
- 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
The woman should be counseled on the issues mentioned below:
- Help the woman to plan and prepare for birth (birth preparedness/micro birth plan).
- This should include deciding on the place of delivery and the presence of an attendant at the time of the delivery.
- Advantages of institutional deliveries and risks involved in home deliveries.
- 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.
- Educate the woman and her family members on signs of labour and danger signs of obstetric complications.
- Emphasize the importance of seeking ANC and PNC.
- Advise on diet (nutrition) and rest.
- Inform the woman about breastfeeding, including exclusive breastfeeding.
- Provide information on sex during pregnancy.
- Warn against domestic violence (explain the consequences of violence on a pregnant woman and her foetus).
- Promote family planning.
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:
- 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.
- 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.
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 practitioner.
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:
- Abdominal or pelvic pain or tenderness,
- 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
- Pain in your shoulder.
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 (also known as preterm labor) is the contractions that are started before 37th weeks of pregnancy.
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
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.
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.
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.
Follow these tips for safe and healthy fitness:
- During exercises, start slowly, progress gradually, and cool down slowly.
- You should be able to talk while exercising. If not, you may be overdoing it.
- Take frequent breaks.
- 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.
- 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.
- 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.
- Don't exercise at high altitudes (more than 6,000 feet). It can prevent your baby from getting enough oxygen.
- Make sure you drink lots of fluids before, during, and after exercising.
- Do not work out in extreme heat or humidity.
- 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:
- Chest pain
- Calf pain or swelling
- Abdominal pain
- Blurred vision
- Fluid leaking from the vagina
- Vaginal bleeding
- Less fetal movement
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?
- Tighten the pelvic floor muscles for a count of three, then relax for a count of three.
- Repeat 10 to 15 times, three times a day.
- 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.
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:
- Lead - found in some water and paints, mainly in homes built before 1978
- Mercury - the harmful form is found mainly in large, predatory fish.
- Arsenic - high levels can be found in some well water
- Pesticides - both household products and agricultural pesticides
- Solvents - such as degreasers and paint strippers and thinners
- 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.
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).
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.
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.
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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- You tube video link of mSakhi, (where 'Sakhi' means 'a friend' in Hindi): An interactive vernacular audio/video-guided mobile application that provides support to ASHAs in conducting routine activities across the continuum of MNCH care
- Obstetric and Neonatal Emergencies
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