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)

ROLE OF EMOTIONS IN CONCEPTION

Fertility is s a natural function of the body just like digestion and circulation. It has two aspects physical and functional.  

Video 1.1 Andal Fertility treatments 

         

Conception = Physical    +       Functional

                        Egg            (Immune               +                     Hormone)

                        

                        Tube                ↓

                                            Diet + exercise                                    ↓

                                                                                          Emotions: Family, Society, Self

                        Uterus

                       

                        Hormones

                        

                        Sperm

Fig 1.1 Role of fertility and conception 

Physical factors: 

It comprises egg, tubes, thyroid, Prolactin hormones, haemoglobin in female and semen parameters in male. All physical factors can be assessed through tests and treatment can be monitored.

Functional aspect: 

The factors that are required and used to be follows

1) Immune factor-the quality of egg and sperm.

2) Hormone function-interplay of FSH, LH, estrogen and progesterone.

IMMUNE FUNCTION: 

Earlier (50 years ago) the natural conception rate was high and abortion rate was low. Now it’s the reverse. Egg and sperm quality are affected by the food we consume.

Hormone function:

The process of conception is a natural function. The coordinated functions of ovary, tube and uterus culminate in conception. Hormones function comprises of   perfect balance of hormones FSH and LH, estrogen and progesterone. FSH and LH  are released from the pituitary gland in the brain and The pituitary is controlled by hypothalamus in the brain, which is the  seat of emotions. So hypothalamus is the final remote control; the hormones seem to dance to the tunes of the emotions.

Fig 1.2 Hormonal Functions

Emotions on conception:

Conception----Natural (Not thinking about pregnancy)

                           Stress ----Delay in conception

           Positive mind set---- Quick and easy conception

when we don’t think about pregnancy occurs naturally  at the rate of 10-20% per month that’s how when 100 couples  are married , 80-90 % conceive naturally in one year without treatment.

Fig 1.3 Child in Mothers womb

When we are under stress (anxious, worried, depressed) and negative belief,--stress hormones  are released  that disturb normal hormone balance and delay the conception.

 Stress -----.>acute stress-exam, financial, marital conflict, acute stress hormones—adrenaline and nor adrenaline.

Chronic stress-daily hassles  

Chronic stress hormones—Cortisol.

When we are happy, confident, secure ,positive belief --happy hormones

(b- endorphin and serotonin) are released-they enhance conception. So quick and easy will be the conception. It only has to be seen to be believed.

Thyroid and Prolactin hormonal variations also influence this Reproductive hormonal  balance.

Fig 1.4 Starting Conception Stage 

Let me share my experiences about how I learnt the impact of stress and diversion on conception.

One day   hyma married for 7 years came with +ve pregnancy test. And I was surprised at it. She had been taking treatment from so many doctors for the past 3 to 4 years. She was very desperate about her pregnancy and her physical factors were normal. 

Fig 1.5 Emotional Health and Pregnancy  

She said for the last  2 months she was very busy in the marriage arrangements of her sister-in-law. There were no elders in the family; so she was  totally involved and exhausted  that there was no time to think bout pregnancy. 

She asked me one pertinent question “ when I was taking treatment why I did not conceive, when I stopped treatment  how I could conceive so easily” That question left me perplexed and then I started the search. With in 3 weeks I had three similar cases like hyma .

In  These cases there was common factor of distraction resulting in conception. One lady was actively involved in house construction. Another was busy in the preparation of exam. The third one lost her brother suddenly in an accident and  in bereavement reaction. After seeing all these conceptions.

Fig 1.6 |Fetal Devleopment

 I realized these conception were not accidental or coincidental .there must have been a conducive atmosphere that facilitated conception. It occurred to me that it was the  expectation, anxiety and stress that prevented conception to occur(when physical factors are alright). 

Video 1.2 Excess Oestrogen and pregnancies

Every one conceives only when she is not thinking about it. That means it is the natural function of the body just like digestion and other metabolic activities. 

We interfere with conception by our negative thoughts .when we stop thinking negatively we allow the body function naturally. This gave me lot of relief and immense confidence.