A rather alarming percentage of women of child-bearing age do not disclose their pregnancies or seek the necessary medical attention until after the first trimester (first 12 weeks of pregnancy) has passed – unless they have some type of complication. Undoubtedly the first trimester is the most crucial part of the development of the unborn child as it is in this period there is complete differentiation of cells and formation of organs of the body as we know it.
It is during this period that abnormalities may occur due to the use of medications, drugs, alcohol and even smoking.
If you are pregnant or become pregnant, your health care provider should be informed at the earliest to guide you, ensuring that you have an optimal pregnancy and the desired outcome.
On your first visit you will be asked the date of the first day of your last period. This date is used to calculate your gestational age (GA), expected date of delivery (EDD) and it will also be used to estimate if the fundal height of your abdomen is adequate.
A normal pregnancy lasts about 40 weeks and is divided into 3 trimesters.
Appointment Schedule:
This will depend on whether or not it is your first pregnancy and if there are any complications. A minimum of at least 10 appointments are necessary but if this is your second pregnancy and there are no complications, at least 7 appointments are recommended. The number of appointments will increase depending on if you suffer from a chronic illness or if there is a complication during pregnancy.
1st Visit Tests:
- Haemoglobin (if less than 11.0 g/dl, the expecting mother may feel tired, lightheaded and experience palpitations. You will be given a supplement with iron and folic acid)
- Blood Group
- Antibody Screening
- Rubella Immune Status
- Hb Electrophoresis (sickle cell test)
- Urine dipstick (protein, sugar)
- Papsmear
- Urine for urinalysis and culture (asymptomatic bacteriuria- urinary tract infection)
- Serology Status : HIV, Hepatitis B and C, Syphilis test (VDRL,RPR), HTLV test
- Ultrasound Scan – to assess the gestational age of the foetus
16 – 20 Weeks:
AFP (alfa-fetoprotein) test (for fetal malformations)
High Resolution Ultrasound – sex, malformations, adequate fetal growth and weight
28 weeks:
Repeat Haemoglobin
Regular Visits after 20 weeks of gestation will include:
- Blood pressure checks
- Urine test (for protein or sugar)
- Abdominal Palpation (doctor will feel your tummy to determine the position of the baby)
- Fundal height (to measure your uterus and determine if there is adequate growth of the baby)
- Feotal heart rate assessment
Common symptoms and signs in pregnancy
Nausea and vomiting – Most women develop an aversion for certain foods or may have episodes of vomiting on mornings. This usually resolves spontaneously or with the use of gravol. In the case of incontractible vomiting coupled with dehydration, hospitalization may be necessary for the safety of both the mother and child.
Vaginal Discharge – There is a physiologic increase in vaginal discharge during pregnancy. If this increase is accompanied by pain, offensive odor, itching or vaginal soreness, a vaginal swab should be done to assess the causative agent.
It should be noted that many women suffer from candidiasis vaginal (yeast infections) during pregnancy and this may be recurrent. Yeast infections consist of a white, thick, clumpy vaginal discharge accompanied by itching but it is odorless. Topical antifungal medication such as Clotrimazole (Canesten) is used as treatment.
Heartburn – This symptom may be due to your diet and the necessary dietary changes should be made or antacids can be used. As the gestational age of the foetus increases and the gravid abdomen develops, the pregnant mother may be subject to more frequent episodes of heartburn.
Constipation – Diet and physiologic changes can result in a sluggish gastrointestinal tract. Increased dietary fiber and adequate intake of water and other liquids are necessary to relieve this condition.
Haemorrhoids – This results from lax veins in the rectum, increased pressure from the growing abdomen and poor diet. Increased dietary fiber, water and the use of hemorrhoid creams can relieve the discomfort.
Backache – This is usually caused by the increased bearing of weight from the gravid abdomen. Assuming a good posture when sitting and standing can bring some relief. A firm mattress and massage therapy may also help alleviate this problem.
Complications arising during Pregnancy
Some illnesses may occur during the pregnancy of a previously healthy individual. In such cases a medical specialist may be needed to provide specialised care and supervision. Hospitalisation and/or delivery of the baby may at times be necessary to save the lives of both mother and child. Proper care and adequate information should be provided if any of the following complications arise:
Maternal
- Gestational diabetes
- Moderate to severe anemia
- Pregnancy-induced hypertension
- Pre-eclampsia and eclampsia
- Renal disease in pregnancy
- Thromboembolism (Deep Vein Thrombosis-DVT and Pulmonary Embolism-PE)
- HELLP Syndrome
Exercise in Pregnancy
If you have been moderately active and there are no complications in your pregnancy it is advised that you continue exercising and also include Kegal exercises (pelvic floor exercises).
Sexual Intercourse during Pregnancy
Sexual intercourse is not known to be associated with any adverse outcomes of pregnancy. If you have a complete placenta previa (the internal cervical opening is completely covered by the placenta), cervical incompetence (the cervix starts to open (efface and dilate) prematurely) or vaginal bleeding occurs, your healthcare provider will advise on sexual activity during pregnancy.
Air Travel
Most women are working mothers. If your career requires constant air travel there may be an increased risk of venous thrombosis on long flights. This is a blood clot that forms within a vein. If you wear venous stockings and stand, walk or pace at least every hour during the flight, this may help ease the problem.
Some airlines, especially on international flights of four hours duration or more, require a letter from your physician confirming that it is safe for you to travel after the 36th week of pregnancy. Most international airlines restrict air travel by pregnant women in the last 2 weeks of pregnancy.
Car Travel
There is no restriction except in cases of long journeys. In such instances if you are pregnant, it is advised that you stop every hour to exercise as this aids in blood circulation. All pregnant women should use a three-point seatbelt. Proper use of the seat belt should be enforced, that is ensuring it passes above and below the gravid abdomen and not across it.
Note:
This is a basic overview of the topic and it’s meant to provide you with some helpful tips on antenatal care. It is important to note that antenatal care is provided on an individual basis and the care you receive is determined by the circumstances of your pregnancy. Adequate consultation with your healthcare provider is necessary during pregnancy, so wnsure that you visit your doctor regularly.
