Pregnancy Care and Treatments

GOAL OF ANTENATAL CARE – HAPPY & HEALTHY MOTHER AND BABY

Pregnancy is divided into 3 trimesters for our convenience

1st trimester	2nd trimester	3rd trimester
Formation of Fetus	Growth of Fetus	Maturity around 37 weeks and preparatory stage for delivery

Fig 1.1 Pregnancy Care and Treatments 

FIRST TRIMESTER (Formation of Fetus) : - 1,2,3 months of pregnancy

History taking:

1)    Age

2)    Married life

3)    LMP : EDD

4)    CONSANGUINEOUS / NON-CONSANGUINEOUS

5)    History of previous pregnancies

6)   Any medicines using for Diabetes, Hypertensions, Hypothyroidism, Epilepsy,

          Asthma or Psychiatric problems.

7)   Family History of Diabetes, Hypertension, Twins, Anomaly babies.

8)   Weight, BP, look for Anemia and swelling of feet.

  Routine investigations:- 

   HB%, Blood group, Urine Micro, RBS, T4, TSHScreening tests – HBsag,  Tridot,HCV, VDRL

       Scan:- 

     

           a) Dating Scan:- To the site of pregnancy, Gestational age, Viability fetus.

         
           b) NT Scan (11-13 weeks):- To rule out down’s Syndrome.

     

       Double Marker Test:- 

     

          Done in patients aged > 35years & in all precious pregnancies to rule out down’s           syndrome

     

       AVOID:-  

            
           Sexual contact, Spicy food, Weight lifting, Journeys.

       MEDICINES:-  

           Folic Acid, B12 (B-complex)

     

Fig 1.2 First Trimester during pregnancy 

  Any other drugs should be used only with Doctor’s Advice (Prescription).

SECOND TRIMESTERS (GROWTH OF FETUS):- 4,5,6 Months of pregnancy

Routine Examination:-  Weight, BP, Height of Uterus, Fetal heart rate (Doppler)

Tests:-

• HB%, RBS/PPBS/GCT, Urine Micro          
• Any infection in Urine à Advise to take more liquids and frequent voiding of Urine, keep nails cut.
• Repeated infection in urine à Urine culture/Sensitivity and add Antibiotics. White Discharge:- Anti Fungal, Anti Micro bials if warranted.

Fig 1.3 Second Trimisters during pregnancy 

Scan:-

TIFFA SCAN(Targeted imaging for fetal anomalies) at 20 to 24 weeks

 Most of the anomalies can be identified during TIFFA Scan.

Limitation of Ultra Sono Graphy

1.     Some anomalies develop late in pregnancy

2.  Some of the anomalies like Gastrointestinal tract anomalies,Multiple Cardiac anomalies are difficult to identify

3.  Only structural anomalies can be identified, functional anomalies like speech,  hearing, vision can be identified only after birth.

Fig 1.4 Scan At pregnancy 

MEDICINES:

1.     Iron tablets from 4^th month -  To prevent Anemia

2.     Calcium tables from 5^th month – To strengthen bones and teeth of baby

3.     DHA (Omega-3 fatty acids) from 7^th month – To improve IQ of baby.

Fig 1.5  Medicine to be followed in pregnancy 

ALL THREE MEDICINES CAN BE CONTINUED AFTER DELIVERY.

EXERCISES:

1.     Walking.

2.     Breathing exercises.

3.     Household work.

THIRD TRIMESTER (Maturity of fetus around 37 weeks preparatory stage for delivery):- 7, 8, 9 Months of pregnancy.

CHECK UP:

• Till 7^th month à Monthly Checkup
• 8^th month        à Once in 2 weeks checkup
• 9^th month        à Weekly once checkup

v Normal weight gain is 2kg/month

v If more than 2kg weight gain à look for fluid retention in body seen as swellingof feet, face, abdomen, hands etc.

Fig 1.6 Trimesters of pregnancy 

    

  i) Mainly pregnancy induced hypertension, Anemia, Hypoprotenaemia                                                    

  ii) Rarely Cardiac, Renal causes.

INCASE OF PREGNANCY INDUCED HYPERTENSION/PREECLAMPSIA

1.     Patient should come for frequent checkup and should be under close monitoring to prevent ECLAMPSIA.

2.  To report immediately if there are any imminent symptoms of Eclampsia like            headache, blurred vision, Epigastric pain(vomiting), decreased urine output,              increased pedal edema.

3.     Advise à Diet, Rest and treatment.

SCANS:-

Growth Scan – 8^th Month

9^th Month Scan – 37 weeks.

Emergency visits to hospital in 9^th Month

Leaking, Bleeding, Fever, Pain Abdomen, Decreased Fetal Movements

TESTS:-

• HB%, RBS/PPBS/GCT, Urine Micro
• At 35 weeks à BT, CT, Platelet count, Serum Creatinine, Serum Bilirubin

DIET DURING PREGNANCY

Diet during pregnancy should be adequate to provide

1.     Good Maternal Health

2.     Optimum Fetal growth

3.     Strength and vitality during labour

4.     Successful lactation

Fig 1.7 Diet and Healthy food During Pregnancy 

IRON (40mg/day):-

·     Increases oxygen carrying capacity in blood, prevents – weakness infections Increases pain bearing capacity, improves lactation in mothers, Decreases premature labour and low birth weight of the baby.

1.     Heme iron 

à Animal Sources

à Red meat, egg, fish

2.     Non Heme Iron 

à Vegetable source

à Green Leafy vegetables, Spinach, beans, peas, carrot,beetroot, tomato, potato, broccoli, lentils.

à FRUITS: Straw berry, Apple, Pear, Peach, Plums.

à IRON BOOSTING FRUITS: Citrus, Melons, Guava

à DRY FRUITS: Dates, Figs, Raisins

à SEEDS: Almond, Cashew, Sunflower seeds, Pumpkin seeds, Jaggery,

            Using iron utensils for cooking.

CALCIUM: (1000mg/day): 

• Helps in building bones and teeth of baby

Sources: 

Milk 300mg, Yogurt – 370mg, Cheese, Sesame seeds – 200mg,Spinach – 250mg, Cabbage, Cauliflower, Broccoli, Orange – 60mg, Date – 15mg, Almonds, Figs, Raisins.

                                 

Video 1.1 Normal pregnancy and Treatments 

Calcium Absorption:

• Increased by Vitamin D and Magnesium.
• Decreased by salt, Coffee, Alcohol,
• Phytates (nuts and grains) and oxalates in spinach

PROTEIN (60grams/day): 

• Building block of tissues

Milk – 8gm, Curd – 10gm, Cheese – 14gm, Lentil 1 cup – 15gm, Beans 1 cup – 18gm, Nuts and seeds, Egg – 6gm, Chicken – 27gm, Fish – 23gm.

Fig 1.8 Protein During Pregnancy

FOLIC ACID(400 Micrograms/day):

Prevents:

1.     Neural tube defect

2.     Down’s Syndrome

3.     Recurrent abortions

4.     Preeclampsia

5.     Low birth weight

Sources:-

• Lentils, Spinach and Orange.

OMEGA – 3 Fatty acids (DHA 300mg)

Fetus:-

1.     Brain and Eye development

2.     Decrease low birth weight

3.     Decrease allergy and eczema

Mother:- 

• Decrease pre-eclamptic toxemia, Depression

Sources:- 

• Flax Seeds, Walnuts, Cold water fatty fish (Salmons, Sardine, Cod fish,   HALIBUT)