Normal Pregnancy

Posted On April 6, 2018

Normal Pregnancy

Introduction: Pregnancy is a unique period in a woman’s life time.  Each and every moment of that wonderful period remains in a woman’s mind for years to come.  The various changes that occur during one’s pregnancy, the various people who encourage you in pregnancy, and the innumerable doubts that come to one’s mind during that period, come as flash backs throughout  a woman’s life.

  What follows is a list of  questions that a normal obstetrician faces in her day to day practice from pregnant patients.  Scientific answers to those questions follow.

  1. Am I pregnant?

The cardinal symptom that gives suspicion of pregnancy is the missing of normal menstruation on the expected day.  This may be accompanied by symptoms like nausea or vomiting.  However, a positive diagnosis of pregnancy cannot be made on these symptoms alone, for the following reasons:

  1. Delayed periods may be caused by mental tension, change in the hormonal milieu of the woman, etc.
  2. Similarly, nausea and vomiting may be caused by indigestion, acidity, etc.
  3. Positive diagnosis of pregnancy in the early days is currently made by the examination of urine pregnancy kits.

Pregnancy test kits: 
Urine of the pregnant woman is collected in a clean dry bottle.  Most of the pregnancy kits come in the form of cards with  2 depressions in it.  Urine is placed in one of the depressions and the result is read in the rectangle beside it. If there are 2 dark lines in the rectangle, the test is said to be positive, meaning, the woman is pregnant.  If there is only one dark line the test is negative, meaning, the woman is not pregnant.

Timing of urine testing: The test becomes positive as early as 2 days after a missed period.
In precious pregnancies, like in women who have conceived after treatment of infertility,  blood level of a substance called  HCG is  measured to determine if she has conceived.
The use of an ultrsonography is frequently used to confirm pregnancy.  Ultrasonogram is commonly called “Scanning”or ultrasound scan.  It uses sound waves to detect changes in the body organs.

The foetus, after conception usually lies in a bag called the gestational sac inside the uterus.  The detection of this sac inside the uterus on scanning is confirmatory of pregnancy.The sac appears 1 week after missed period.    2 weeks after a missed period, the heart beat of the foetus can be seen on the scan, confirming that the foetus is alive.

Safety of USG: Ultrasonography is generally safe in pregnancy and there are so far no reports of any documented abnormalities in a fetus caused by ultrasonography in pregnancy. Millions and millions of ultrasonography has so far been done world over in pregnancy.

Clinical examination: Enlargement of the uterus can be perceived clinically by doing a per vaginal examination to know the enlargement of the uterus by about 15 days of missed periods.  However, pregnancy kits currently can diagnose pregnancy much sooner than that, so by and large diagnosis of pregnancy is done by examination of the urine.

  1. Now that I am pregnant, what are the special precautions that I should take?

In an uncomplicated pregnancy, not many special precautions need be taken.  However, the following doubts may arise in the woman’s mind.
a)      Should I take rest?
The fact is that many studies have shown that bed rest does not decrease  the incidence of miscarriages.  Even in sterility conceptions, there is no role for bedrest. A woman can continue to go for work even when pregnant.  The reason why many doctors advocate bedrest in precious pregnancies is probably because bedrest does not harm any pregnant woman and it is a popular and probably unshakable belief that bedrest can prevent mishaps in pregnancy.  However, if there is vaginal bleeding after a confirmed pregnancy, rest is essential.
b)      Can I travel?
Ordinary travel, by  bus, car, autorikshaw, aeroplane, etc is permissible in early pregnancy.  However, while traveling by two-wheelers, care must be taken not to travel for long distances through very bumpy roads.
c)      Is intercourse permissible?
In uncomplicated pregnancies, there is no bar for intercourse during pregnancy.

  1. What special food should I take during pregnancy ?

In the first 3 months of pregnancy, many pregnant women suffer from nausea and vomiting.  This is said to be a protective mechanism to ward of noxious substances in food.  In the first 3 months, the organs of the baby are formed and it is theorized that this protective mechanism prevents congenital anomalies in the foetus.
Since it is a period of general uneasiness for the woman, it is best to allow her to eat whatever she fancies.  There should be no restriction on food fads during this time.  She should take whatever little she can at frequent intervals.  If she is not able to eat solid food, taking a glass of lemonade with lots of sugar or glucose powder might help.  Ginger is said to be helpful in allaying vomiting.  Taking dry food stuffs like crackers early in the morning soon after getting up from bed can prevent morning sickness.  High protein diet like an egg or pulses while going to sleep is also useful.
In the period after the first 3 months: 
After the period of organogenesis(The time when the organs of the foetus are being shaped) in the first three months is over, the woman tends to vomit much less and she begins to tolerate food much better.  From the fourth month onwards, the baby begins to grow and the mother has to provide nutrients, both for herself and for her growing baby.   She has to have a balanced diet containing carbohydrates , fats, proteins , minerals and vitamins.

  • The usual diet contains enough of carbohydrates.  In addition , the woman should be advised to take one half –boiled egg  per day to provide for proteins.  In vegetarians, a diet rich in pulses and grams can act as substitutes.  If this is difficult to take, there are many protein powders in the market and  daily allowances of protein can be completed from them.
  • The bone of the growing baby demands additional calcium supplimentation.  Calcium is available in milk and green leafy vegetables. Deficiency in calcium intake can lead to high blood pressure in pregnancy.
  • Pregnancy pushes the stomach up and may cause acidity.  Restriction of fried foods and spicy foods can prevent aggravation of this condition.
  • In pregnancy the bowel movements are sluggish due to increased levels of a hormone called progesterone.  The iron and calcium supplementation during pregnancy may aggravate the constipation already caused by the sluggish bowel movements.  Taking grapes, high fibre diet, like green leafy vegetables, or drinking a glass of warm water at night can relieve this symptom to some extent.
  1. Symptoms of Pregnancy: 
    There are many symptoms peculiar to pregnancy as a result of many physiological changes in the pregnant woman’s body.

Vomiting and Nausea: The first three months of pregnancy are  usually accompanied by a tendency for nausea and vomiting.  Usually it is not of a magnitude that requires medication.  The woman is encouraged to take frequent small meals .  She should avoid oily foods.  The smell of fried food may be offensive at this time and it would be useful to avoid such odours.  The quantity of food taken may be inadequate due to nausea and this may lead to a feeling of being tired and sometimes giddiness may ensue.  Many pregnant women and their caregivers mistake giddiness to be a sign of  anaemia, high blood pressure or even some other serious illness. The difficulty of taking enough to go on with normal work can , to some extent be overcome  by taking  frequent sips of glucose water or sugared lemonade   The solution should have  high quantities of glucose, or sugar instead of the usual 2 teaspoonfuls.  Glucose is a simple sugar and is digested immediately and even if the woman vomits after a while, she gets the calories she needs.

Taking dry biscuits or crackers early in the morning, high protein diet at night, etc are some other ways of combating this symptom.

Sometimes, nausea and vomiting may prove to be too much to carry on with routine activities, and at such times there should be no hesitation in taking some medications on the prescription of a doctor.  Most of these medications are safe in pregnancy.  Many women fear that taking medications may lead to anomalies in the baby and try to avoid them .  This leads to uncontrollable vomiting.   Medicines on a doctor’s prescription should be taken freely to control this symptom without fears of anomalies to the foetus.

Sometimes inspite of medication, there may be uncontrollable vomiting and this may need admission to a hospital and intravenous drips.  This happens when excessive vomiting causes a condition called ketoacidosis in the body. This leads to more vomiting and further vomiting aggravates the ketoacidosis, thus creating a vicious cycle.  Intravenous drips at this stage stops ketoacidosis and controls vomiting.

Some women continue to have nausea throughout pregnancy .  Some of this is due to gastritis and can be controlled with simple medications.

High temperature: 
The need to provide energy for the growing baby increases the metabolic rate of the pregnant woman and she may feel warm all the time.  Many women feel concerned at this and feel that they have fever of some pathological origin.  The presence of  increased amounts of the hormone called progesterone may also contribute to slight elevations in temperature.  No medications are needed for this kind of “fever”. Whenever a woman feels feverish, it is best to document the rise in temperature using a thermometer and confirm it.  This will prevent undue anxiety over many a so called “fever”.  However, very high temperature may indeed be due to some pathological cause and certainly needs prompt therapy.  Infections may present with high temperature, and if untreated, will lead to death of the foetus.
Abdominal pain:
Pain in the abdomen causes alarm in most pregnant women.
-Occasional pain in the abdomen may be due to colics or it may be due to the presence of harmless cysts in the ovaries.       These need not be a source of worry.
 –If the pain is severe, medical attention is warrantedas it could be due to many conditions related or unrelated to pregnancy.
– In later pregnancy, intermittent abdominal pain may be symptom of impending labour.
-Abdominal pain just above the hairline may be due to bladder infections.
-A discomfort felt in the lower abdominal region in later pregnancy may be due to stretch on the ligaments attached to the    uterus.
-Severe constipation may lead to stasis of gas in the intestines, leading to colics.

Intermittent abdominal pain in the latter half of pregnancy may be a sign of preterm labour  and should receive immediate medical attention.

Burning sensation:
The growing uterus in the abdomen displaces the stomach and intestines.  This leads to acidity and a burning sensation in the abdomen.  Simple antacid therapy may cure it.

The pelvis is a bony cavity which initially houses the uterus and it is through the outlet of the pelvis that the baby comes out of the body.  In preparation for the birth of the baby, the ligaments, (fibrous bands uniting the bones) of the pelvis become lax.  The relative increased mobility of the bones leads to backache in some patients.  Back ache is aggravated by wrong postures.  As far as possible , the pregnant woman should walk straight.  As the abdomen enlarges, there may be a tendency for the woman to push her tummy out and this will worsen the back ache.
Normally, the baby lies with it’s back lying just below the mother’s abdominal wall.  In occipito-posterior positions, the back of the baby will be in front of the maternal spine and nearby structures.  The baby is literally lying on it’s back.. In such patients, backache is more pronounced.
Back ache may be relieved by simple hot fomentation or local pain-relieving balms.  Paracetamol tablets, normally used to treat fever is also useful for severe cases of backache.  Aspirin, and other regular painkillers are best avoided in the latter half of pregnancy as these may cause abnormalities in the circulatory system of the growing foetus.
Many patients complain that when they take rest, they do not have any backache, but when they start working, they suffer from backache.  It would be best to limit physical activities to the extent that does not cause backache, rather than taking a lot of medications to be able to give 100% work performance.
Backache coming on at regular intervals in the latter half of pregnancy could be a sign of impending labour and needs medical intervention.
 Backache caused by contractions in the uterus comes at regular intervals as opposed to a continuous dull aching pain that is usually seen.
5.Traditional belief about  precautions in pregnancy:

There are many do’s and don’ts in Indian traditional belief . Some of them are listed below.
1..Papaya can cause abortions: Ripe papaya cannot cause abortion and is in fact rich in VitaminA.
2.Pineapple can cause abortion: There are no modern scientific studies to prove this fact.
3.Saffron flower can make the baby fair: the colour of the offspring is determined by the genetic make-up of the parents.  No change in food habits of the mother can influence the colour of the baby.
4. Pregnant women should not sleep in the afternoon: We do not know why this belief came about.
5.Pregnant women should sleep on one side: This is true as the weight of the enlarged uterus will fall on the large blood vessels by the side of the spinal cord if the woman lies on her back , thus impeding circulation.
6.A woman should expose her tummy by wearing sarees during pregnancy to avoid jaundice in the newborn:
There is no scientific evidence to this hypothesis.