Prenatal Care

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How Often Should I Have Prenatal Care Visits?

The frequency of your prenatal visits with us may vary depending on your age and your risk of potential complications. Here is the proper prenatal care schedule for a healthy woman between the ages of 18 and 35:
  • Every 4 to 6 weeks for week 1 to 32.
  • Every 2 to 3 weeks for 32nd week to 37th week.
  • Every week from week 37 until delivery.
High-risk pregnancies may require more frequent appointments.

The First Trimester (0 to 13 weeks)

During the first trimester, your baby’s physical structure and organs develop, making this period pivotal for their growth. Unfortunately, this is also the time when most miscarriages and birth defects occur. Some women experience nausea during the first trimester, commonly known as “morning sickness,” though it can occur at any time of day.
However, every pregnancy is unique, and not all women will experience the same symptoms. Some may experience food cravings, while others may have food aversions or no change in appetite. Additionally, your breasts may become tender, larger, and heavier, while your uterus grows and presses on your bladder, causing more frequent urination.

Your emotions

During the first trimester, it’s common to experience a spectrum of emotions. Hormonal fluctuations that will lead to mood swings and irritability, while tiredness often accompanies the early months of pregnancy. These feelings are normal, so consider discussing them with your partner or a close friend. However, if you find yourself feeling down or experiencing heightened anxiety, it’s essential to seek guidance from your doctor or midwife.

What happens to the baby?

During the first trimester, your baby transforms from a fertilized ovum into a fetus approximately 6 cm long at 12 weeks. Remarkably, by the end of this period, your baby’s heart begins to beat, while the brain, stomach, and intestines take shape. Additionally, small protrusions known as ‘buds’ appear, marking the initial development of arms and legs.

Visit to the Obstetrician:

Your pregnancy will likely be verified via a urine or blood test at your initial prenatal checkup, which provides greater accuracy than at-home pregnancy tests. During the first trimester, antenatal checkups typically occur every 4 to 6 weeks. Many women are provided with an ultrasound scan around week 12, during which they may hear their baby’s heartbeat. This ultrasound can also reveal multiple births (such as twins), estimate the baby’s size and due date, and detect certain health conditions.
Other health checks during the first trimester include:
  • Urine tests to identify urinary tract infections, which are common but treatable; if left unchecked, they can lead to preterm labour.
  • Blood tests to determine your blood type, particularly Rh status, as well as to assess iron levels, blood glucose (for gestational diabetes), rubella (German measles) immunity, and to screen for infections like HIV, hepatitis B, and syphilis.
  • General assessments of maternal health and well-being, including discussions about any concerns related to pregnancy or overall health, and a review of medications, including natural or alternative methods, to ensure they are safe for use during pregnancy.

How to stay healthy?

If you smoke, now is an ideal time to quit. Avoiding alcohol entirely during pregnancy is the safest option, as even small amounts, especially in the first trimester, can have lasting negative effects on your baby. Focus on eating a balanced diet rich in nutrients, which will support both your baby’s development and your own health.
Although your calorie intake won’t increase significantly in the first trimester, certain nutrients become more important. Many women need to take folic acid and iodine supplements, as it’s challenging to get enough of these nutrients from food alone. Regular physical activity is crucial during pregnancy, offering numerous benefits for both you and your baby. If you encounter any discomfort or issues, consult your doctor or midwife.

Things to consider in the first trimester

  • Schedule your antenatal appointments for the entire trimester—they are necessary for monitoring your health and your baby’s development.
  • Don’t hesitate to seek support—invite your partner, a friend, or a family member to accompany you to your health checkups.
  • Ensure your vaccinations are current, as immunisation is crucial. Pregnant women may qualify for several vaccines covered under the National Immunisation Program, so consult your doctor for advice.

What to expect during routine pregnancy visits?

4-8 Weeks Gestation

  • Confirm pregnancy through a urine test.
  • Conduct lab work and perform a Pap smear or annual exam, if needed.
  • Provide new obstetric education and informational packet.
  • Discuss the option of genetic testing.
7-9 Weeks Gestation

  • Confirm pregnancy with a urine test.
  • Perform a Pap smear or annual exam, if necessary.
  • Offer new obstetric education and provide a packet.
  • Conduct an ultrasound to check viability and establish dates.
  • Draw prenatal lab work.
  • Discuss genetic testing options.
12 Weeks Gestation

  • Routine prenatal check-up with the physician.
  • Continue with monthly appointments.

The Second Trimester (14 to 26 weeks)

The middle section of your pregnancy is often referred to as the “golden period” by many because the discomforts of the first trimester tend to subside. During this time, you’re likely to experience less nausea, improved sleep, and a boost in energy. However, your body will still undergo significant changes.
As your uterus expands, you may feel some discomfort or aches from the stretching ligaments. The skin on your belly and breasts will also stretch, which can cause mild itching and possibly lead to stretch marks, although these usually fade with time.
Even though your baby is still under a kilo in weight, your blood volume will increase to support the rapid growth, which will contribute to some weight gain. It’s not uncommon to experience anxiety, and some women might develop symptoms of an anxiety disorder. Antenatal depression, a mood disorder characterized by intense emotional fluctuations, can also occur and goes beyond the typical emotional changes expected during pregnancy.

What happens to the baby?

During the second trimester, your baby undergoes remarkable development. In week 13, they measured around 7.5 cm in length and weighed about 30 grams. By week 26, they will have grown to approximately 23 cm and 820 grams. Your baby will have enough space to move around in the amniotic sac, and you may begin feeling these movements, often described as light flutters or tickles, around week 19—possibly even earlier if you’ve been pregnant.
Your baby’s organs, including the liver, pancreas, and kidneys, will start to function during this period. Some babies may begin thumb-sucking during this time. During week 20, your baby can hear sounds, such as your heartbeat, and will start to recognize your voice, even though their ears are still developing.

What will you expect at your antenatal visits?

Frequent antenatal visits are essential in maintaining your health and your baby’s well-being. The frequency of these visits will vary based on your circumstances, but typically, many women have appointments every 4 to 6 weeks. During your second trimester, your healthcare provider will check your blood pressure and examine your hands and feet for swelling at each visit.
You may also be weighed, have blood samples taken for tests, and undergo a urine analysis. Additionally, your doctor will assess your abdomen to track your baby’s growth and listen to the baby’s heartbeat. If you didn’t have an ultrasound during the first trimester, you might be offered one around 18 to 20 weeks.
16 Weeks Gestation

  • Routine prenatal appointment
  • AFP testing may be offered
20 Weeks Gestation

  • Ultrasound to assess fetal anatomy
  • Optional gender determination
  • Routine prenatal appointment following the ultrasound
24 Weeks Gestation

  • Routine prenatal appointment
  • Lab work for gestational diabetes and anemia screening after a glucose drink test

The Third Trimester
(27 to 40 Weeks)

As you enter the third trimester of pregnancy, you’re past the halfway mark, and your baby’s arrival is drawing nearer. This stage brings with it a mix of excitement and tasks to prepare for the big day. You might either slow down or burst with energy, driven by the “nesting” instinct—a strong desire to clean and organize for your baby’s arrival. The growing size of your uterus, expanding from about 0.5 kg before pregnancy to 1 kg by delivery, contributes to many of the symptoms experienced during this time.
In these final months, you may notice the following changes:
  • Your skin and ligaments will continue to stretch to accommodate your growing baby.
  • You might feel more fatigued, and sleeping can become increasingly challenging.
  • As your baby grows, you may experience heartburn and/or breathlessness.
  • Braxton-Hicks contractions may occur. They are characterized by irregular, non-painful tightening of the uterus that lasts around 30 seconds. These are not labour contractions and do not indicate the start of labour.
For first-time mothers, around 36 weeks, you may observe that your baby has moved lower into your pelvis, a phenomenon known as “engagement” or “dropping.” This shift may provide some relief around your ribs but can increase pressure on your bladder, leading to more frequent bathroom trips.
In the final weeks, your body starts preparing for labour. The cervical area begins to soften, and many women notice a “show,” which is the release of the mucous from the cervical canal. This is an early sign that labour may soon begin.

Emotional Changes

As you approach the end of your pregnancy, feelings of anxiety or worry about labour, delivery, and parenting may arise. Discomfort in bed and frequent trips to the bathroom can disrupt your sleep, potentially leading to irritability and low mood. While many women view the third trimester as an exciting time and are optimistic about the future, approximately 20% may experience antenatal anxiety or depression. If you’re struggling, seeking help earlier is crucial.

Your Baby's Development

By 31 weeks, your baby’s lungs are becoming more mature, though they still need to produce surfactant to aid breathing after birth. By 36 weeks, your baby is approximately 47 cm long and weighs around 2.6 kg. The baby’s head may start to lower into the pelvis, preparing for delivery. About 4% of babies will be in the breech position rather than head-down at the start of labour. If this occurs, your healthcare provider do discuss your options and the implications for your delivery. By 40 weeks, your baby will be around 50 cm long and weigh about 3.4 kg, fully developed and ready for birth.

What to Expect from Your Doctor

During the third trimester, you will have frequent antenatal visits: approximately every 4 weeks until 36 weeks, and then every 2 weeks thereafter. Weight gain is typical during pregnancy, with most women gaining between 11 and 16 kg. Using a pregnancy weight gain calculator can help you track your progress. Staying active is important throughout pregnancy, even in the third trimester. Safe, gentle exercise is encouraged for women without complications as part of a healthy lifestyle.
28 Weeks Gestation

  • Drink a glucose solution before your appointment (you can eat your meal prior).
  • Routine prenatal appointment.
  • Complete CBC to screen for anaemia.
  • Possible screening for syphilis (RPR).
  • RhoGam administration if necessary.
  • Begin bi-weekly appointments.
  • Schedule a repeat C-section, if applicable.
30 Weeks Gestation

  • Routine prenatal appointment.
  • Discuss your birth plan and expected delivery type.
32 Weeks Gestation

  • Routine prenatal appointment.
  • Boostrix (Tdap) vaccine may be offered.
34 Weeks Gestation

  • Routine prenatal appointment.
36 Weeks Gestation

  • Routine prenatal appointment.
  • Group B Beta Strep test.
  • Cervical check.
  • Begin weekly appointments.
37 Weeks Gestation to Delivery

  • Routine prenatal appointments with physician and cervical checks.

Pregnancy
Ultrasound

A pregnancy ultrasound is a vital tool for capturing images of a developing baby and the mother’s pelvic organs throughout pregnancy. This procedure relies on sound waves, rather than radiation like X-rays, to produce visual images on a monitor. It is considered safe, with no known risks, and can be performed from the fifth week of gestation through to delivery. Ultrasound provides a remarkable view of your baby’s growth.
The process involves using a small handheld device on the abdomen for a pelvic ultrasound, or a probe inserted into the vagina for a transvaginal ultrasound. This device sends sound wave data that is converted into images on a screen. Selected images can be stored digitally or printed.
In the early stages of pregnancy, ultrasounds can confirm a healthy pregnancy, detect multiple pregnancies, and estimate the embryo or fetus’s age. They are also used to identify ectopic pregnancies, investigate bleeding, or check for signs of miscarriage. By around six weeks, the baby’s heartbeat can often be seen on the ultrasound.
As the pregnancy progresses, ultrasounds monitor the baby’s size and position within the uterus, assess the placenta’s condition and placement, and measure the amniotic fluid level. They can also screen for Down syndrome or other developmental issues. You may even see your baby move, breathe, suck a thumb, or hiccup. Before delivery, an ultrasound helps determine the baby’s and umbilical cord’s position to aid in planning a safe birth.
The frequency of ultrasounds during pregnancy varies based on individual circumstances. Some doctors routinely perform screening ultrasounds, while others reserve them for when there’s a potential issue. Women with high-risk pregnancies may require more frequent ultrasounds compared to those with low-risk pregnancies.

Treatment

Before your test, you might be required to drink several glasses of water. A full bladder can improve the clarity of images in an abdominal ultrasound. It’s essential to only urinate if instructed. During the procedure, you’ll lie on your back on an examination table while a radiology technician or doctor applies a conductive gel to your skin. They will then gently move the ultrasound device over your lower abdomen to capture images. Typically, this procedure is painless or only mildly uncomfortable.
For a transvaginal ultrasound, you will need to have an empty bladder. You’ll undress from the waist down and cover yourself with a sheet. Lying on your back with your feet in stirrups, the technician will carefully insert a transducer into your vagina to obtain images. You may experience slight discomfort or pressure during this procedure.

3 Types of Prenatal Ultrasound Exams

There are three main types of prenatal ultrasound exams:
  1. Standard Ultrasound Exam: This is the most common type of ultrasound, used to monitor the fetus’s development, screen for significant congenital anomalies, and estimate gestational age. It can also provide information about the fetus’s position, movement, heart rate, size, amount of amniotic fluid, the placenta’s location, and the number of fetuses.
  2. Limited Ultrasound Exam: A limited ultrasound is focused on addressing a specific concern, such as determining the fetus’s position if you are in labour or checking for a heartbeat in cases of vaginal bleeding.
  3. Specialized Ultrasound Exam: This type of exam is conducted when a potential issue is identified based on risk factors or other tests. It may involve advanced techniques like Doppler or 3-D ultrasonography to monitor the fetus’s growth or investigate other suspected problems.

How many ultrasound exams will I have during my pregnancy?

You should have at least one standard ultrasound exam between 18-22 weeks of pregnancy. In some cases, an ultrasound may be performed in the first trimester, though this is less common. Early ultrasounds can help estimate gestational age, screen for certain genetic disorders, count the number of fetuses, check the fetal heart rate, or detect an ectopic pregnancy.

Pregnancy Lab
Tests, Blood &
Urine Tests

Pregnancy
Vaccination

During pregnancy, your immune system undergoes changes that make you more vulnerable to certain infections and illnesses, which could be harmful to both you and your developing baby. Vaccination offers a straightforward and effective means of protecting you and your baby from specific infections. By preparing your immune system, vaccines help it respond effectively if exposed to the disease.
Vaccines typically contain small amounts of dead or weakened viruses or bacteria, known as antigens. These antigens stimulate the immune system, training it to recognize and combat the disease without causing illness. If you encounter the infection later on, your body is better equipped to defend against it. While most vaccines are administered through injections, some are given as oral drops.

The following vaccines are routinely recommended during pregnancy:

Whooping Cough
(Pertussis):

Whooping cough poses a significant risk, particularly for infants under six months old, as it can lead to severe illness or even death. A single dose of the pertussis vaccine should be received between 20 and 32 weeks of each pregnancy. This vaccination helps transfer antibodies to your baby through your bloodstream, providing protection. It also lowers your risk of contracting whooping cough and passing it on to your newborn.

Influenza (Flu):

The flu can be particularly dangerous during pregnancy, doubling your likelihood of requiring hospitalization compared to non-pregnant individuals. The influenza vaccine is safe and effective, reducing the risk of severe flu-related complications. Pregnant women are capable of receiving the flu vaccine for free by the National Immunization Program before, during, or after pregnancy. Since the flu virus evolves each year, receiving the updated annual vaccine ensures you’re protected against new strains. This also helps prevent the spread of influenza to your family. Babies are especially susceptible to complications from the flu, and getting vaccinated during pregnancy will extend protection to your newborn during their first six months of life.

Pregnancy Medication

Many medications taken during pregnancy can pass through the placenta and affect the baby. Some may pose risks, so it’s crucial to consult your doctor before beginning, altering, or discontinuing any medication.

Taking Medication
During Pregnancy

Many women need to take prescription medications during pregnancy for conditions like diabetes, epilepsy, depression, anxiety, and other health issues. Some medicines are also used to manage common pregnancy discomforts such as heartburn, morning sickness, or headaches. Pregnancy can alter how medications work in your body. With an increase in blood volume and heightened activity in your heart and kidneys, medications may be processed faster than usual, possibly requiring dosage adjustments. Your doctor may prescribe a different type of medication to ensure your medical needs are met while reducing any potential risks to your baby.

Challenges In Pregnancy

Ectopic Pregnancy

An ectopic pregnancy causes when a fertilized egg grows outside the uterus, mostly in one of the fallopian tubes. When the pregnancy advances, it can lead to a rupture of the tube, which may result in severe internal bleeding and pose a life-threatening emergency that requires immediate surgical intervention. Several factors can increase the risk of an ectopic pregnancy, including:
  • A previous ectopic pregnancy
  • Past surgeries on the fallopian tubes
  • Previous pelvic or abdominal surgeries
  • Certain sexually transmitted infections (STIs)
  • Pelvic inflammatory disease
  • Endometriosis
  • Smoking
  • Being over the age of 35
  • A history of infertility
  • The use of assisted reproductive technologies, such as in-vitro fertilization (IVF)

Symptoms of
ectopic pregnancy:

Initially, an ectopic pregnancy may present with symptoms similar to those of a typical pregnancy, such as a missed period, breast tenderness, or nausea. However, additional signs that may indicate an ectopic pregnancy include:

  • Unusual vaginal bleeding
  • Lower back pain
  • Mild discomfort in the abdomen or pelvis
  • Slight cramping on one side of the pelvis
At this stage, distinguishing between a typical pregnancy and an ectopic pregnancy can be challenging. It’s essential to inform your obstetrician about any abnormal bleeding or pelvic pain.

As the ectopic pregnancy progresses, more severe symptoms may arise, particularly if a fallopian tube ruptures. These symptoms may include:

  • Sudden, intense pain in the abdomen or pelvis
  • Pain in the shoulder
  • Weakness, dizziness, or fainting
A ruptured fallopian tube can lead to dangerous internal bleeding. If you experience any sudden, severe pain, shoulder pain, or weakness, seek immediate medical attention by visiting an emergency room.

Diagnosis of Ectopic
Pregnancy:

If there are no signs of a ruptured fallopian tube, but your obstetrician suspects an ectopic pregnancy, they may take the following steps:

  • Conduct a pelvic examination
  • Test an ultrasound to determine the location of the pregnancy
  • Better test your blood for the pregnancy hormone human chorionic gonadotropin (hCG)

Treatment of
Ectopic Pregnancy:

Since an ectopic pregnancy cannot be relocated to the uterus, treatment is always necessary. Two primary methods are used: medication or surgery, and both require several weeks of follow-up care.
Medication, such as methotrexate, may be prescribed if the pregnancy has not caused a rupture in the fallopian tube. The decision to use this treatment depends on several factors, including your ability to undergo regular blood tests to monitor hCG levels.
If the fallopian tube is damaged, emergency surgery is required. In some cases, surgery may be necessary even if there is no rupture. During the procedure, the ectopic pregnancy may be taken off from the tube, or the entire tube, along with the pregnancy, may be removed.

Future pregnancies

After experiencing an ectopic pregnancy, your risk of encountering another one increases. For any future pregnancies, it’s crucial to stay vigilant for symptoms of an ectopic pregnancy until your obstetrician verifies that the pregnancy is developing in the correct location.

Pregnancy Loss
(Early & Recurring)

What is Early Pregnancy
Loss (Miscarriage)?

Early pregnancy loss refers to the loss of a pregnancy before 13 weeks of gestation. It is often termed a miscarriage or spontaneous abortion. This type of pregnancy loss is relatively common, occurring in approximately 10% of known pregnancies.

What Causes Early
Pregnancy Loss?

A significant number of early miscarriages are caused by improper embryonic development, often due to an abnormal number of chromosomes. Chromosomes, found in each cell of the body, carry the genetic information that dictates how a person develops and functions.
During fertilization, the egg and sperm merge, bringing together two sets of chromosomes. If the egg or sperm has an abnormal number of chromosomes, the resulting embryo will also have an abnormal chromosome count, which can lead to a miscarriage.

Are there certain activities that cause early pregnancy loss?

In nearly all cases, miscarriage is not the result of anything a woman did. It’s crucial to understand that miscarriage typically occurs as a random event. Activities such as working, exercising, experiencing stress, having sex, or using birth control pills before pregnancy do not cause miscarriage. Few medications are linked to miscarriage, and morning sickness—a common early pregnancy symptom—does not contribute to it either.
Some women who experience miscarriage may attribute it to a recent fall, trauma, fear, or stress, but this is rarely the case. Often, these events coincide with the miscarriage but are not the cause.
Age and Miscarriage Risk
The likelihood of miscarriage increases with a woman’s age. For women over 40, approximately 1 in 3 pregnancies end in miscarriage, often due to chromosomal abnormalities.
There is also some evidence suggesting that chromosomal abnormalities in the embryo might increase as men age, but the specific age at which this risk begins is not well-defined.

What are the signs and symptoms of early pregnancy loss?

Signs and Symptoms of Early Pregnancy Loss

he most common sign of a miscarriage is vaginal bleeding. It is important to contact your obstetrician if you experience any of the following symptoms:
  • Vaginal spotting or bleeding, with or without pain.
  • A sudden gush of fluid from the vagina, even if there is no pain or bleeding.
  • Passage of tissue from the vagina.
While light bleeding early in pregnancy is common and doesn’t always indicate miscarriage, heavy bleeding or cramping similar to menstrual pain warrants immediate medical attention.

Diagnosis

If you have symptoms such as bleeding or cramping, your doctor may perform an ultrasound to assess the pregnancy’s progress. If the pregnancy is far enough along, the ultrasound might detect cardiac activity.
However, if no cardiac activity is found, it may be too early to detect, or it could indicate that the embryo has stopped developing. Additionally, a blood test measuring human chorionic gonadotropin (hCG) levels may be conducted, as low or decreasing hCG levels can indicate pregnancy loss. Multiple ultrasound exams and hCG tests might be necessary to confirm a miscarriage.
Your doctor may also conduct a pelvic exam to determine if your cervix has begun to dilate, which can suggest that a miscarriage is more likely.

Treatment After Miscarriage

Sometimes, some pregnancy tissue remains in the uterus after a miscarriage, known as an incomplete miscarriage. Several options are available to remove this tissue, depending on the stage of the pregnancy and other factors. If your blood type is Rh negative, you may receive an Rh immunoglobulin (RhIg) injection after an early pregnancy loss to prevent complications with the Rh factor in future pregnancies.

Future Pregnancies After a Miscarriage

Most first-trimester miscarriages are isolated events. Many women who experience an early pregnancy loss go on to have successful pregnancies. Recurrent miscarriages are uncommon.

Repeated
Miscarriages

What is recurrent
pregnancy loss?

Recurrent pregnancy loss is defined as having two or more miscarriages. After two miscarriages, a thorough physical exam and testing are recommended.
A small number of women have repeated miscarriages. It’s estimated that fewer than 5 in 100 have two miscarriages in a row.
Most common causes: About half of miscarriages occur randomly when an embryo receives an abnormal number of chromosomes during fertilization. This type of genetic problem happens by chance. There is no medical condition that causes it. But the chance of this problem increases with age.
In a small number of couples who have repeated miscarriages, one partner has a chromosome in which a piece is transferred to another chromosome. This is called a translocation.
People who have a translocation usually do not have any physical signs or symptoms, but some of their eggs or sperm will have abnormal chromosomes. If an embryo gets too much or too little genetic material, it often leads to a miscarriage.
Some medical conditions may increase the risk of repeated miscarriages:

  • Certain congenital problems of the uterus
  • Asherman syndrome
  • Fibroids and polyps
  • Antiphospholipid syndrome (APS)
  • Diabetes mellitus
  • Thyroid disease
  • Polycystic ovary syndrome (PCOS)
In over half of women who experience recurrent miscarriages, the exact cause often remains unidentified, despite potential indicators of an underlying issue.

Pregnancy
Complications

High-Risk Pregnancy:

A high-risk pregnancy is one that poses a threat to the health or life of the mother or the fetus, often requiring specialized care from obstetricians. Various factors can cause to a high-risk pregnancy, including:
  • Advanced Maternal Age: Women over 35 years old face higher risks of complications such as preeclampsia and gestational hypertension.
  • Lifestyle Choices: Habits like smoking, alcohol consumption, and drug use can significantly increase pregnancy risks.
  • Maternal Health Conditions: Pre-existing conditions such as high blood pressure, obesity, diabetes, epilepsy, thyroid disorders, heart or blood diseases, poorly managed asthma, HIV, and infections can elevate the risk of pregnancy complications.
  • Pregnancy-Related Complications: Issues like an abnormal placenta position, restricted fetal growth (less than the 10th percentile for gestational age), and Rh sensitization—where the mother’s Rh-negative blood is incompatible with the baby’s Rh-positive blood—can pose serious risks.
  • Multiple Pregnancy: Carrying more than one fetus, such as twins or triplets, heightens the risk of preeclampsia, preterm labour, and premature birth. For example, over half of twins and up to 93% of triplets are born before 37 weeks.
  • Pregnancy History: A history of pregnancy-related hypertension, such as preeclampsia, or previous preterm births, increases the likelihood of these issues recurring in future pregnancies.
  • Overweight and Obesity: Being overweight or obese raises the chances of developing high blood pressure, preeclampsia, gestational diabetes, stillbirth, neural tube defects, and the likelihood of a cesarean delivery. Research also shows that maternal obesity can increase the infant’s risk of congenital heart defects by 15%.

Anemia:

During pregnancy, the body changes to support the growing baby, including an increase in blood volume—from approximately 5 liters when not pregnant to 7-8 liters by the end of pregnancy. This process requires additional iron, vitamin B12, and folate to produce the extra hemoglobin necessary for the increased blood volume. Iron deficiency is the primitive cause of anemia during pregnancy, as pregnant women need three times more iron than when not pregnant. However, because iron is difficult to absorb, many women become anemic without iron supplements.
Anemia in pregnancy can also result from insufficient folate and vitamin B12, bleeding, or conditions such as preeclampsia or sickle cell disease. Anaemia means having too few red blood cells responsible for carrying oxygen throughout the body. Those cells are produced in the bone marrow and contain hemoglobin, a protein essential for oxygen transport. Mild anemia during pregnancy is common and may cause fatigue. Severe anemia, however, can lead to symptoms such as shortness of breath, weakness, dizziness, irritability, and difficulty concentrating.
To prevent anemia during pregnancy:

  1. Begin your pregnancy in good health.
  2. Maintain a healthy diet during pregnancy.
  3. Take iron supplements if necessary.

Bleeding During Pregnancy:

Bleeding during pregnancy, particularly in the early stages, is fairly common, with about 1 in 4 women experiencing vaginal spotting or bleeding during the first trimester. Most of these cases result in healthy pregnancies. However, vaginal bleeding can also be an early indication of a complication, so it’s crucial to consult your obstetrician if you experience bleeding at any stage of your pregnancy to determine the appropriate course of action.
The causes of bleeding during pregnancy are typically categorized into two groups: bleeding before 20 weeks and bleeding after 20 weeks of gestation.
Before 20 weeks of gestation, there are various reasons for bleeding, including:

  • Implantation bleeding: In the beginning stages of pregnancy (around 4 to 5 weeks), some women might experience light bleeding as the embryo implants itself into the uterine lining.
  • Miscarriage: Bleeding can sometimes be an early indicator of a miscarriage. Approximately 1 in 15 women who experience early pregnancy bleeding may miscarry.
  • Ectopic pregnancy: This rare but critical condition occurs when the fertilized egg starts to grow outside the uterus, potentially causing significant bleeding if it ruptures, which can be life-threatening.
In later stages of pregnancy (after 20 weeks), bleeding is often linked to issues with the placenta, such as:

  • Placenta previa: Also called a “low-lying placenta,” this condition occurs when the placenta is positioned close to the cervix. If the cervix dilates or the uterus contracts, bleeding may occur.
  • Placental abruption: It will happen when the placenta separates from the uterine wall before birth, leading to bleeding. This condition is usually accompanied by sudden, intense abdominal pain.
Other causes of bleeding may include:

  • Infections in the genital tract
  • Injuries to the genital tract
  • Growths or tumors within the reproductive system
  • Varicose veins in the vulva or vagina (vulvovaginal varicosities)
It’s helpful to document specific details of your symptoms, such as the amount and color of any discharge, the presence of clots, and whether you’ve experienced abdominal pain.
Your healthcare provider would recommend a blood test to measure your human chorionic gonadotropin (hCG) levels. This hormone, produced by the placenta, can offer insights into how your pregnancy is progressing. An ultrasound scan may also be suggested to:
  • Check your baby’s heartbeat
  • Assess for signs of miscarriage
  • Look for indications of an ectopic pregnancy
  • Evaluate the position and condition of the placenta
Determining the cause of bleeding may require multiple blood tests or ultrasound scans over time. While bleeding in early pregnancy is common and doesn’t always signify a miscarriage, it’s essential to monitor and seek medical guidance to ensure the best outcome.

Gestational Diabetes

Gestational diabetes is a one of the forms of diabetes that emerges during pregnancy. It occurs when the body cannot effectively use sugar (glucose), resulting in elevated blood sugar levels. This condition can pose health risks for both the mother and the baby. Unlike pre-existing diabetes, gestational diabetes specifically develops during pregnancy.
Approximately 1 in 8 pregnant women are diagnosed with gestational diabetes, typically between the 24th and 28th weeks of pregnancy, though it can sometimes occur earlier. Often, there are no noticeable symptoms, and the condition is usually identified through routine prenatal testing.

Causes:

During pregnancy, the placenta produces hormones that support the baby’s growth. However, these hormones can also cause insulin resistance, making it harder for the body to use insulin effectively. Pregnant women need 2 to 3 times more insulin than usual, and if the body can’t meet this increased demand, blood sugar levels may rise too high.

Risk Factors:

You may be more likely to develop gestational diabetes if you:
  • Are above a healthy weight range or gain excessive weight early in pregnancy
  • Are over 35 years old
  • Have a family history of type 2 diabetes
  • Have previously had gestational diabetes
  • Have polycystic ovary syndrome (PCOS)
  • Have previously delivered a large baby
  • Are taking certain anti-psychotic or steroid medications

Diagnosis:

Gestational diabetes is usually diagnosed between 24 and 28 weeks of pregnancy through an oral glucose tolerance test (OGTT). If you are at higher risk, testing may be done earlier. The OGTT involves fasting for 10 hours, followed by a blood test, drinking a glucose solution, and additional blood tests over the next two hours to monitor your body’s response.

Management:

If diagnosed with gestational diabetes, managing your blood sugar levels is crucial. You may be referred to a dietitian and might require more frequent prenatal visits for monitoring. Proper management helps protect both your health and that of your baby.

Maintaining a Healthy Diet

For women managing gestational diabetes, a balanced diet is essential. Here are some key guidelines:

  • Incorporate carbohydrates into each meal and snack. Aim to distribute your carbohydrate intake across three smaller meals and two to three snacks daily.
  • Eat a diverse range of foods that provide the necessary nutrients for pregnancy.
  • Opt for high-fiber foods.
  • Avoid items high in sugar.
  • Limit your intake of fats, particularly saturated fats.

Exercise

Engaging in moderate-intensity physical activity, which increases your heart rate or breathing, can be beneficial for controlling blood glucose levels and minimizing insulin resistance. Walking is an excellent exercise option to integrate into your daily routine if you have gestational diabetes. However, always consult your doctor before starting any new exercise regimen during pregnancy.

Medication

Medication may be necessary if diet and exercise adjustments do not sufficiently control your blood sugar levels. Insulin injections and metformin pills are considered safe for the unborn baby. If you had diabetes prior to pregnancy, it’s essential to discuss with your doctor whether any adjustments to your medication are needed.

After Birth

Following delivery, your baby will require close monitoring due to the possibility of low blood glucose levels. A heel prick blood test will be performed within 2 to 4 hours after birth to check their glucose levels. To help stabilize your baby’s blood glucose, aim to feed them within 30 minutes of birth.
If you had gestational diabetes during pregnancy, you can stop any treatment immediately after delivery. However, you should have your blood glucose levels tested before leaving the hospital and again at your 6-week postpartum check-up. Additionally, you will receive guidance on diet and exercise.
Breastfeeding is particularly beneficial for mothers with a history of gestational diabetes, as it aids in regulating both your weight and your baby’s weight.
While gestational diabetes often cannot be avoided, maintaining a healthy weight can lower your risk. If you were overweight before pregnancy, losing some weight beforehand is advisable.
If you have gestational diabetes in previous pregnancy, you would have a higher likelihood of developing it again. Your doctor will conduct an oral glucose tolerance test around 12 to 16 weeks and again at approximately 26 weeks to monitor your blood glucose levels.

Complications of Gestational Diabetes

Uncontrolled blood sugar levels during pregnancy do lead to various complications, such as having a larger baby, miscarriage, or stillbirth. A larger baby may result in complications during birth and an increased likelihood of requiring interventions like a cesarean section. However, your baby will not be born with diabetes.
Women having gestational diabetes are also at an increased possibilities of having high blood pressure during pregnancy and face a 50% higher risk of developing type 2 diabetes later in life. Additionally, their babies are at greater risk of developing type 2 diabetes in the future

Pre-eclampsia

Pre-eclampsia is a serious condition that can develop after the 20th week of pregnancy, characterized by elevated blood pressure and potential impact on several organs like the liver, kidneys, and brain. Without proper treatment, it can result in severe complications for both the mother and baby.
This condition is among the most common serious disorders during pregnancy. Mild pre-eclampsia affects about 10% of pregnancies, while severe cases occur in roughly 1% of pregnancies. Early detection and treatment are important to avoid life-threatening outcomes.
Certain factors may increase your risk of developing pre-eclampsia, including:

  • A history of pre-eclampsia in previous pregnancies
  • Chronic high blood pressure
  • Diabetes
  • Autoimmune disorders like lupus or antiphospholipid syndrome (APS)
  • Mental health issues like depression or anxiety
  • Use of assisted reproductive technology
Additionally, pre-eclampsia is more likely if you:

  • Are over 40 years old
  • Are experiencing your first pregnancy
  • Haven’t been pregnant in over 10 years
  • Are significantly overweight
  • Have a family history of pre-eclampsia
Many women with pre-eclampsia do not exhibit noticeable symptoms, and it is often detected during routine prenatal visits. However, if pre-eclampsia is severe, it can lead to kidney issues and the presence of protein in the urine.

Symptoms of pre-eclampsia:

  • Sudden or rapid swelling in the hands, face, or feet
  • Dizziness
  • Persistent headaches not relieved by typical painkillers
  • Vision disturbances like flashing lights or spots
  • Severe pain below the ribs
  • Persistent heartburn despite antacids
  • Overall feeling of being unwell
Your obstetrician will monitor your blood pressure at each appointment to ensure it remains within normal limits. If high blood pressure is detected, further tests may be conducted to diagnose pre-eclampsia. These tests could include a urine analysis for protein, blood tests to evaluate kidney and liver function, and physical examinations to assess reflexes. Additionally, your baby’s health will be monitored with ultrasounds and heart rate assessments using a cardiotocograph (CTG).

Treatment:

If you have mild to moderate pre-eclampsia, your doctor might prescribe blood pressure medications and treatments to prevent blood clots. The only cure for pre-eclampsia is your baby’s delivery. To manage the condition, your doctor may suggest inducing labor early. The timing of this will depend on factors such as how many weeks pregnant you are, the size of your baby, and the severity of your pre-eclampsia.
Most women with pre-eclampsia who are on prescribed medications and give birth to their baby experience no complications. However, some may face serious issues like seizures, stroke, kidney failure, liver failure, or bleeding due to clotting problems.
After experiencing pre-eclampsia, you may be at a higher chances of increasing high blood pressure, heart disease, diabetes, or ongoing clotting disorders later in life. Your doctor might recommend more frequent check-ups to catch and manage these conditions early.

Impact on the Baby

Pre-eclampsia can impair the function of your placenta, potentially affecting your baby’s growth and increasing the risk of premature birth. If your baby is born prematurely or smaller than expected, they might need care in a neonatal unit.
Although many pre-eclampsia symptoms improve after delivery, it can take several days or longer for your condition to stabilize, and some blood test results might worsen before improving. High blood pressure can persist for up to three months after birth.

Future Pregnancies

If you’ve had pre-eclampsia, you are at risk of experiencing it again in future pregnancies. Before planning another pregnancy, consult with an obstetrician who can help manage your blood pressure and reduce the risk of complications.

Hyperemesis Gravidarum: Severe Nausea Disease and Vomiting in Pregnancy

Key facts
Hyperemesis gravidarum is defined as a severe form of nausea and vomiting during pregnancy that goes beyond typical morning sickness. It will lead to dehydration, malnutrition, and other health issues, such as anxiety and difficulty with daily tasks. Most people with hyperemesis gravidarum require hospitalization for intravenous fluids and treatment.
Hyperemesis gravidarum is defined as a severe form of nausea and vomiting during pregnancy that goes beyond typical morning sickness. It will lead to dehydration, malnutrition, and other health issues, such as anxiety and difficulty with daily tasks. Most people with hyperemesis gravidarum require hospitalization for intravenous fluids and treatment.
Treatment aims to manage nausea and vomiting with various medications. Although symptoms may not entirely disappear, the goal is to enable you to consume some food and fluids. If you experience excessive salivation or if vitamins make you feel unwell, you may consider discontinuing pregnancy multivitamins, but continuing folate is advisable if possible.
Hyperemesis gravidarum can affect placental function, potentially resulting in a smaller or prematurely born baby.

Cervical Cerclage for Cervix weakness:

Cervical cerclage is a procedure used to help prevent preterm birth by stitching the cervix closed. This treatment is generally performed during the second trimester for those with cervical insufficiency, where the cervix is not strong enough to stay closed as the pregnancy progresses.

Diagnosis:

Your obstetrician may recommend a cerclage if you have experienced:

  • Pregnancy loss due to painless cervical dilation in the second trimester
  • Multiple second-trimester losses or preterm births
  • Previous cerclage due to cervical dilation
A cerclage may also be advised based on:

  • Painless cervical dilation in the second trimester
  • An ultrasound showing a short cervix with other preterm birth risk factors
A cerclage is typically performed in a hospital and does not require an overnight stay. A transvaginal cerclage is usually removed around 37 weeks, either during an office visit or in the hospital, while a transabdominal cerclage may remain until delivery via cesarean section. It can also be retained between pregnancies to prevent future issues.
After a cerclage, you might experience:

  • Light bleeding or spotting for up to three days
  • Increased vaginal discharge
  • Mild cramping
If you notice spotting or discharge, use sanitary pads and avoid inserting anything into your vagina. Limit heavy activity and consult your obstetrician before resuming sexual activity.
While the risk of complications from a cerclage is low, potential issues include:

  • Preterm pre-labour rupture of membranes (PPROM)
  • Infection of fetal membranes and uterus
  • Cervical tears
  • Stitch displacement
  • Bleeding during or after the procedure

Alternative to Cerclage:

An alternative to a cerclage is a pessary, a soft, removable device placed in the vagina, which may benefit some women.
Nandhini – Pearl Hospital, a leading Muti speciality hospital in Velachery, Chennai, has been dedicated to women’s wellness for over 35 years, offering comprehensive gynaecological, fertility, cancer care, and specialty care treatments for women. Our team of expert obstetricians has safely delivered over 50,000 babies.
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