pregnancy care

 

 

Medical care during pregnancy (prenatal care)

 

 

Morning sickness:

About half of the women who get nausea during pregnancy feel complete relief by about 14 weeks. For most of the rest, it takes another month or so for the queasiness to ease up, though it may return later and come and go throughout pregnancy. A small percentage of women have symptoms that persist continually (or nearly so) until delivery.

Of course, just because morning sickness is common—and likely to last "only" a few monthsdoesn't mean it's not a challenge. Even a mild case of nausea can wear you down, and bouts of round-the-clock nausea and vomiting can leave you exhausted and miserable. Talk with your caregiver about your symptoms and the possibilities for relief..

 

Hyperemesis gravidarum

What is hyperemesis gravidarum?

For a minority of pregnant women (up to 2 in 100 pregnant women), the sickness and vomiting are prolonged and very severe. This causes them to become low in body fluid (dehydrated) and to lose weight. They may also develop vitamin deficiencies. Because they are not able to eat, the pregnant woman can develop signs of starvation. This is shown by looking for the presence of substances called ketones in the urine (using a simple test on a sample of urine). Ketones are produced if your body is forced to break down fat for energy if you are vomiting and are unable to keep food down.

This severe sickness and vomiting are known as hyperemesis gravidarum. These women often need to be admitted to hospital for intravenous fluids and other treatment.

 

What causes sickness and vomiting in pregnancy?

The exact cause of the sickness is not known. It is probably due to the hormonal changes of pregnancy. Nausea and vomiting tend to be worse in twin and other multiple pregnancies.

There are a number of risk factors that may make you more likely to experience nausea and vomiting in pregnancy.

These include the following:

 

*** If you are having a female baby.

*** If this is your first pregnancy.

*** If you have had - or your mother or sister has had - nausea and vomiting in previous pregnancies.

*** If you are having twins or another multiple pregnancy.

***If you have a history of motion sickness.

*** If you have a history of migraines.

*** If you have experienced nausea when taking the combined oral contraceptive pill.

*** If you are stressed or anxious about something.

*** If you are obese.

*** If you are a younger woman.

 

Many women, especially those with mild to moderate nausea and/or vomiting, do not need to see a healthcare provider for treatment of nausea and vomiting. The suggestions below may help to reduce symptoms and prevent dehydration.

Women with more severe nausea and vomiting sometimes need to be evaluated by their primary care or obstetrical doctor or nurse.

 

Seek help if you have one or more of the following:

Signs of dehydration, including infrequent urination, dark-colored urine, or dizziness with standing .Vomiting repeatedly throughout the day, especially if you see blood in the vomit Abdominal or pelvic pain or cramping

If you are unable to keep down any food or drinks for more than 12 hours you lose more than 5 pounds (2.3 kg)

One or more tests may be recommended to investigate the cause and determine the severity of the nausea and vomiting, including blood tests, urine tests, or an ultrasound.

 

Tratment of  nausea and vomiting in pregnancy:

The treatment of pregnancy-related nausea and vomiting aims to help you feel better and allow you to eat and drink enough so that you do not lose weight.

Treatment may not totally eliminate your nausea and vomiting. You may need to try several types of treatment over a period of weeks before finding what works best for you. Fortunately, symptoms generally resolve by mid-pregnancy, even if you do not use any treatment.

 

Dietary changes — Avoiding food or not eating may actually make nausea worse. Try eating before or as soon as you feel hungry to avoid an empty stomach, which may aggravate nausea. Eat snacks frequently and have small meals (eg, six small meals a day) that are high in protein or carbohydrates and low in fat. Drink cold, clear, and carbonated or sour fluids (eg, ginger ale, lemonade) and drink these in small amounts between meals. Smelling fresh lemon, mint, or orange or using an oil diffuser with these scents may also be useful.

Avoid triggers — One of the most important treatments for pregnancy-related nausea and vomiting is to avoid  odors,  tastes, and other activities that trigger nausea.

Eliminating spicy foods helps some women. Other examples of triggers include:

*** Stuffy rooms

*** Odors (eg, perfume, chemicals, coffee, food, smoke)

*** Heat and humidity

*** Noise

*** Visual or physical motion (eg, flickering lights, driving)

*** Excessive exercise

*** Being tired

*** Consuming large amounts of high-sugar foods/snacks

*** Consuming spicy foods and high-fat foods

Brushing teeth after eating may help prevent symptoms. Avoid lying down immediately after eating and avoid quickly changing positions.

If you take a prenatal vitamin with iron and this worsens your symptoms, try taking them at bedtime. If symptoms persist, stop the vitamins temporarily. If you stop taking your prenatal vitamin, take a supplement that contains 400 to 800 micrograms of folic acid until you are at least 14 weeks pregnant to reduce the risk of birth defects

Medications — Medications that reduce nausea and vomiting are effective in some women and are safe to take during pregnancy. None of the medications discussed below are known to be harmful. Make sure you talk with your healthcare provider before taking any new over the counter or prescription medications, including nutritional and herbal supplements.

Vitamin B6 and doxylamine — Vitamin B6 supplements can reduce symptoms of mild to moderate nausea, but do not usually help with vomiting. Doxylamine is a medication that can reduce vomiting, and may be combined with vitamin B6. Doxylamine is available in the United States in some non-prescription sleep aids (eg, Unisom, Good Sense Sleep Aid) and as a prescription antihistamine chewable tablet (Aldex AN). Combinations of vitamin B6 and doxylamine formulations are available for the initial treatment of nausea (eg, Diclectin in Canada and Diclegis in the United States).

Antihistamines and other anti-nausea medications — Antihistamines and other anti-nausea medications are safe and effective treatments for pregnancy-related nausea and vomiting. The following medications may be recommended:

Diphenhydramine (Benadryl), but this drug may cause drowsiness

Meclizine (Bonine), but this drug may also cause drowsiness

Other anti-nausea medications that are available by prescription include:

 Promethazine (Phenergan) — Promethazine is available in pill, oral solution, injectable solution, or rectal suppository form. It is usually taken every four hours, and may cause drowsiness and dry mouth. Rare side effects include muscle contractions that cause twisting or jerking movements.

Metoclopramide (Reglan) — Metoclopramide speeds emptying of the stomach and may help to reduce nausea and vomiting. It is available in a pill, oral solution, and injectable usually taken 30 minutes prior to meals and at bedtime.

Ondansetron (Zofran) — Ondansetron is an anti-nausea medication that is usually taken by mouth or injection every eight to 12 hours. Ondansetron is an expensive anti-nausea medication (approximately $500 for 30 pills in the United States) and it may not be covered by some insurance plans.

Fluids and nutrition — If you are unable to hold down food or liquids, you may be treated with intravenous (IV) fluids. This may be done in your doctor or nurse's office or in the hospital, depending upon the severity of your vomiting. For a short time, you may be advised not to eat or drink anything, to allow the gut to rest. You can slowly begin to eat and drink again as you begin to feel better, usually within 24 to 48 hours.

If you continue to lose weight despite treatment, your doctor may consider other forms of feeding, such as the use of a nasogastric tube (a tube that is inserted through your nose into the stomach) or supplemental nutrition through an IV line.

 

Complementary treatments:

The following treatments may be useful when used with the treatments described above.

 

1-Acupuncture and acupressure:

 Acupressure wristbands  and acupuncture have become a popular treatment for nausea and vomiting caused by pregnancy, motion sickness, and other causes. Studies have not shown these wristbands to be more effective than sham (fake, look-alike) wristbands , although some women find them helpful. Acupuncture and acupressure have no known harmful side effects.

2- Hypnotism:

Hypnosis has been reported to be helpful in some people. Counseling may be helpful for women with anxiety.

 

3- Ginger:

Powdered ginger or ginger tea may help to relieve nausea and vomiting in some women. However, further studies are needed to confirm that this treatment is both safe and effective. Until more data are available, we suggest the use of ginger containing foods
(eg, ginger lollipops, ginger ale) for mild nausea and vomiting.

Most women with pregnancy-related nausea and vomiting recover completely without any complications. Women with mild to moderate vomiting often gain less weight during early pregnancy. This is rarely a concern for the baby unless the mother was very underweight before pregnancy (at least 10 percent under the ideal body weight).

Normal weight gain during pregnancy depends upon your pre-pregnancy weight. For women of normal weight (body mass index 18.5 to 24.9 kilogram/meter2) , the recommended weight gain is between 25 and 35 pounds (11.5 to 16.0 kilograms) for a singleton pregnancy.

In women with severe nausea and vomiting (hyperemesis gravidarum) who are hospitalized multiple times and who do not gain weight normally during pregnancy, there is a small risk that the baby will be underweight or small.

Women who have hyperemesis gravidarum in one pregnancy are at risk of severe nausea and vomiting in future pregnancies. The risk is between 15 and 20 percent. Women who do not have severe nausea and vomiting in the first pregnancy are unlikely to have it in future pregnancies.

The major goal of prenatal care is to ensure the birth of a healthy baby with minimal risk for the mother. There are several components involved in achieving this objective:

*** Early, accurate estimation of gestational age

*** Identification of the patient at risk for complications

*** Ongoing evaluation of the health status of both mother and fetus

*** Anticipation of problems and intervention, if possible, to prevent or minimize morbidity

History and physical examination - It is important to identify women at increased risk of maternal medical complications, pregnancy complications, or fetal abnormalities. Early identification of these women gives the provider an opportunity to discuss these issues and their management with the patient and, in some cases, interventions are possible that minimize the risk of an adverse outcome. Ideally, this process is initiated prior to pregnancy during a preconception consultation

The elements of the patient history include:

*** Personal and demographic information

***Past obstetrical history

*** Personal and family medical history

*** Past surgical history

*** Genetic history

*** Menstrual and gynecological history

*** Current pregnancy history 

***Psychosocial information

 

Pregnancy diagnosis:

It’s detectable in mother’s blood. Home pregnancy kits for the detection sensitivity is 91%.

The gestational sac can sometimes be visualized as early as four and a half weeks of gestational age (approximately two and a half weeks after ovulation) and the yolk sac at about five weeks gestation. The embryo can be observed and measured by about five and a half weeks. The heartbeat may be seen as early as 5 weeks of gestational age. It is usually visible by 7 weeks.

Gestational age is usually determined by the date of the woman's last menstrual period, and assuming ovulation occurred on day fourteen of the menstrual cycle.

 

Duration of Natural pregnancy:

Pregnancy is calculated from this day because each time a woman has a period, her body is preparing for pregnancy. Counting from the LMP, most women are pregnant an average of 280 days ( 40 weeks).

 

*** Stages of pregnancy

*** First trimester (week 1-week 12)

*** Second trimester (week 13-week 28)

*** Third trimester (week 29-week 40)

 

Baby movements:

You'll probably start to be aware of something at about 18 weeks to 20 weeks of your pregnancy.

If this is your first pregnancy, it may take you a bit longer to realise that those gentle fluttering feelings in your tummy (quickening) are your baby's movements.

If you've had a baby before, you'll know the tell-tale signs, and may notice your baby moving around as early as 16 weeks.

Either way, if you haven't felt any movement from your baby by 22 weeks,

it  is normal not to feel much movement from my baby in my 22nd week of pregnancy.

 

Weight gain during pregnancy:

Pre-pregnancy weight                                       Recommended weight gain

Underweight (BMI < 18.5)                                28 to 40 lbs. (about 13 to 18 kg)

Normal weight (BMI 18.5 to 24.9)                    25 to 35 lbs. (about 11 to 16 kg)

Overweight (BMI 25 to 29.9)                            15 to 25 lbs. (about 7 to 11 kg)

Obese (BMI 30 or more)                                    11 to 20 lbs. (about 5 to 9 kg)

 

 

Working during pregnancy:

If you're a healthy woman having a normal pregnancy and you work in a safe environment, you may be able to continue working until the day you deliver, or close to it. Toward the end of your pregnancy, though, you may tire more easily, so take it easy if possible.

If your pregnancy is going along smoothly and your job isn't causing any problems for you or the baby, chances are you can work right up until your baby arrives if that's what you want to do.

In certain occupations, you might need to make some modifications during your pregnancy. Some studies have shown that women who work physically strenuous jobs during pregnancy – including heavy lifting, standing for long periods, irregular or excessive hours, and other variables – are more likely to deliver prematurely, have low-birth-weight babies, and develop high blood pressure during pregnancy.

Any job that exposes you to substances proven harmful to a fetus -- including pesticides, some cleaning solvents, lead, and certain chemicals -- can be extremely dangerous. Industries that are considered potentially risky for pregnant women include farming, health care, some factory work, dry cleaners, printing, some crafts businesses (such as painting and pottery glazing), highway or tollbooth jobs (where workers breathe in high levels of lead and carbon monoxide from car exhaust), and the electronics industry.

 

Exercise during pregnancy:

If you're an athlete with a high activity level before pregnancy, I recommend paying more attention to how you feel during exercise than to your heart rate. Always listen to your body. And all newly pregnant women should have a discussion with their healthcare provider about their exercise routine.

As long as you can talk during your workout and don't feel out of breath, then the intensity is most likely appropriate for you. You'll probably need to reduce your intensity level as your pregnancy progresses, but it's still okay to exercise to the point where you feel like you're getting a good cardiovascular workout.

Pregnant women can exercise a moderate intensity for 30 minutes or more per day.

Before you begin an exercise program, make sure you have your health care provider's OK. Although exercise during pregnancy is generally good for both mother and baby, your doctor might advise you not to exercise if you have:

*** Some forms of heart and lung disease

*** Pregnancy-related high blood pressure

*** Cervical problems

*** Vaginal bleeding

*** Preterm labor during your pregnancy or risk factors for preterm labor, such as preterm labor during the pregnancy prior to your current pregnancy

*** A multiple pregnancy at risk of preterm labor

 

There any reason why I should stop exercising during pregnancy?

As mentioned above, there are many benefits of doing regular physical activity whilst you are pregnant. And generally, the benefits of exercising during pregnancy by far and away outweigh any risks. However, there are a few things that you should watch out for. You should stop exercising and seek urgent medical attention if you develop:

*** Excessive shortness of breath.

*** Chest pain or a thumping heart (palpitations).

*** Dizziness or feeling faint.

*** Painful contractions, signs of labour or any leakage of amniotic fluid.

*** Vaginal bleeding.

*** Excessive tiredness.

*** Tummy (abdominal), pelvic or back pain.

*** A severe headache.

*** Feelings of muscle weakness.

*** Multiple pregnancy

*** Calf pain or swelling.

*** Concerns that your baby is moving les

*** Driving during pregnancy

*** Driving during pregnancy won’t be problematic.

*** Place the lap belt under your abdomen, as low on your hips as possible and across your upper thighs.

*** Position the shoulder belt between the breasts.

*** Adjust your safety belt as snugly as is comfortably possible

*** Pregnant women should always wear a full seat belt no matter whether they are sitting in the front or back of the car.

 

Traveling by plane when pregnant:

In the absence of obstetric or medical complications, pregnant women can observe the same precautions for air travel as the general population and can fly safely. Pregnant women should be instructed to continuously use their seat belts while seated, as should all air travelers.

If you have a normal, healthy pregnancy, it can be perfectly safe to fly during most of it. Discuss your trip plans with your doctor or midwife, however, before booking your flight. In certain high-risk cases, your healthcare provider may advise you to stay close to home throughout your pregnancy.

You may find that your second trimester — weeks 14 to 27 — is a perfect time to fly. Once you're past the first trimester, in all likelihood your morning sickness will be behind you, your energy levels will be higher, and your chances of miscarriage will be low. However, you shouldn't travel after 36 weeks.

 

sex during pregnancy:

“sex during pregnancy is extremely safe for most women with uncomplicated, low-risk pregnancies,”

It’s better not to have intercourse after 36th of pregnancy.

 

Dental care during pregnancy:

As a precautionary measure, dental treatments during the first trimester and second half of the third trimester should  not be  avoided as much as possible, except in the case of an emergency.

Studies have shown that dental diseases is associated with preterm labor and pregnancy toxication.

Medical measures are done under local anesthesia.

Avoid dental x-rays during pregnancy. If x-rays are essential, your dentist will use a shield to safeguard you and your baby. Advances in dentistry have made x-rays much safer today than in past decades.

 

Vaccination during pregnancy:

Influenza vaccine should be injected in the flu season.

Infants of pregnant women vaccinated during their second or third trimester can expect to have reduced rates of influenza and influenza-related hospitalization, for their first six months of life.

The flu vaccine helps protect both the mother and the child by preventing or lessening the intensity of influenza

Influenza Vaccine Given to Pregnant Women Reduces Hospitalization due to Influenza in Their Infants.

MMR injection will reduce the risk of  febrile respiratory illness in the infant.

Immunization against hepatitis, tetanus and pneumococcal during pregnancy is ok.

 

Coffine intake during pregnancy:

To manage your caffeine intake, though, you'll need to be aware of other sources, like tea, soft drinks, energy drinks, chocolate, and coffee ice cream.

Drinking two mugs of tea, two mugs of instant coffee or  3 cups coffee of filter coffee a day will keep you within the recommended daily limit of 200mg.

 

 

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