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Pregnancy

Getting Pregnant

Pregnancy is one of the most wonderful events in a couple’s life. Conceiving a child brings utmost joy in the life of a woman making her feeling complete.

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A complex series of events take place in a woman’s body in the process of pregnancy. The central nervous system (mainly the hypothalamus), the pituitary gland, ovary and the uterus (endometrium) each have an active role for the normal reproduction to occur.1 To understand the process one has to know what the process goes on inside a pregnant woman’s body before, during and after getting pregnant.

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Understanding the menstrual cycle can be considered as the first step towards knowing how pregnancy occurs. In short, menstrual cycle is a process of making the woman ready for pregnancy during which an “egg (ovum)” is produced within the ovary.2 The period during which the egg is formed and ready for fusion with the sperm is commonly known as the “fertile period”. In case, if the fusion does not take place the egg along with other tissues is shed out and this process is referred to as the “menses” or “periods”.

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The menstrual cycle is as a result of complex interaction between several hormones including follicle-stimulating hormone (FSH) and luteinizing hormone (LH) (secreted by the anterior pituitary) and estrogen and progesterone (secreted in the ovary).2 These hormones play a vital role in getting the body ready for the pregnancy and maintain it. A number of other hormones and proteins also have either a direct or indirect role in these processes.

The mean menstrual cycle length is indicated to be between 28 and 30 days. In women with a regular 28 day cycle, day 7 to day 21 is considered as the fertile period during which there is a maximum chance of getting pregnant.3 A successful fusion between the egg and the sperm signifies a positive pregnancy and the resulting “embryo” gets implanted in the uterus, where it grows into a baby. The process of fusion and implantation altogether require about 3–4 weeks.

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Morning Sickness

Morning sickness (nausea and vomiting during pregnancy) is noticed in about 50–90% of all pregnancies. It brings mixed feelings of both joy and worry to the pregnant woman and her family. The typical onset is noticed between 4 and 8 weeks’ of pregnancy, which usually improves before 16 weeks. The vomiting is noticed once or twice in a day and the quantity of vomiting is usually less. Certain variations in the body during pregnancy have been attributed as the causative factor. One need not worry about this if occurs once or twice in a day, as the problem tends to decrease as the pregnancy progresses. However, a doctor should always be consulted if there is an increased frequency of vomiting or if it persists for a long time.

The management of nausea and vomiting in pregnancy depends on the severity of the symptoms. The therapy may range from minor modifications such as dietary changes to more aggressive approaches involving antiemetics (medications used to stop vomiting) and hospitalization.

The dietary changes are the initial treatment recommended in mild cases. Pregnant woman may be advised to eat frequent, small meals and to avoid smells and food textures that cause nausea. Ginger is a popular alternative treatment for morning sickness. It has been used since ages as preservatives, in tea and as ginger ale (soft drink flavored with ginger). It is also available in capsule form. It should always be remembered that persistent vomiting may be dangerous and consultation with a doctor is must in such situations.

In case of persistent vomiting, the doctor may advise pregnant woman to take certain medications to stop the vomiting. Severe cases may require hospitalization for 1 to 3 days during, which the mother may be required to consume a liquid diet.8 Solid diet is advised 2 to 3 days after the vomiting is stopped.

How to beat morning sickness during pregnancy

Home Pregnancy Tests

Missing one or more consecutive menstrual periods may be an indicator of the pregnancy.

Other associated signs include

If a woman notices any of these signs, then it’s time for a pregnancy test, which can be done both at home and at a clinic. Home pregnancy test kits are now available as over-the-counter products. These kits are reliable, if they are used according to the direction indicated on it.

human chorionic gonadatropin (hCG)

Once a woman is pregnant, her body begins to secrete increased amounts of a hormone known as human chorionic gonadatropin (hCG), which becomes evident in the urine. The pregnancy test kits usually have a color indicator to identify the presence of this hormone in urine and changes color to indicate pregnancy.

How it can be done

For performing the test, a woman can either hold the strip in her urine stream or collect the urine in a cup and dip the test strip into the cup. If a woman observed a colored line (depending on the brand of pregnancy test kit purchased) it indicates that she is pregnant. For the most reliable results, this test should be performed 1–2 weeks after the woman miss the last period. The first morning urine tends to produce more accurate results.5

Any positive result should be confirmed by consulting with a doctor. If one suspects that she is pregnant but the home test show negative result then, she may either repeat the test after a week to recheck or consult the doctor.

Home pregnancy tests

Pregnancy Calendar: Development of Baby

Human pregnancy usually lasts for a period of about 40 weeks (just more than 9 months), which is calculated from the start of the last menstrual period till childbirth. This gestation period is divided into three trimesters of approximately three months each. The growth of the baby in the womb (uterus) occurs in stages during these three trimesters. Periodic visits to the doctor are required to ensure that both the mother and child are healthy. The mother is also required to follow a healthy lifestyle with a complete abstinence from smoking or consumption of alcohol.

First Trimester (Months 1–3)

The first sign of development of the baby is not evident until the fourth week since the last missed period. During the fourth week, the vital organs such as the brain, spinal cord, heart and other organs starts developing in the primitive baby or the embryo. The blood circulation and heart beat begin during the fifth week of the pregnancy. The heart beat is evident in an ultrasound examination. The fingers and toes of the baby begin to develop during the eight week while the sex of the child is apparent by the end of the eleventh week. First trimester is considered as the most important phase of pregnancy, as the vital organs required for the normal functioning of the body are being formed during this phase. All three trimesters are equally important and proper care helps both the mother and the baby to remain healthy.6 First trimester

Second Trimester (Months 4–6)

The progress of the growth of the baby is also marked by the increase in the width of the waist. It is time to refresh the wardrobe. The organs formed during the first trimester begin to mature during the second trimester and gradually begin to function. The baby’s skin begins to form by the 15th week of the pregnancy. The eyes of the baby begin to become sensitive to light as one reach the 16th week and it can hear by the end of the 18th week. Second trimester

Third Trimester (Months 7–9)

The joy and tension begins to mount as the due date of delivery is fast approaching. The baby within a pregnant woman’s body is growing fast and its presence may be marked by minor movements while she sitting or lying down. By the 29th week of pregnancy the punches and kicks form the baby causes discomfort while it also brings the sense of happiness about the one within her. The different organ systems of the baby are now reaching almost their maturity level and the baby is ready to face the external world. The position of the baby begins to gradually move to a head down position to enable a proper delivery by the 36th week. By the end of the 36th week the baby is considered to have attained the full term. The ultimate day which one is waiting for 9 months may arrive by the 40th week. The due date may either be early or later than that predicted by the doctor.7 Third trimester

Diseases during Pregnancy

Gestational Diabetes

Gestational diabetes (GD) refers to the occurrence of diabetes in a woman for the first time during pregnancy. The variations in the hormone levels in the body and increasing weight have been proposed as the causative factors. A pregnant woman is at risk of developing GD due to the following risk factors:

  • Age more than 25 years.
  • Overweight before pregnancy or gain excessive weight during pregnancy.
  • A family history of diabetes (first-degree relative).
  • Blood glucose level is high, but is not high enough to be termed as diabetes (a condition known as abnormal glucose tolerance).9

The condition is generally identified by performing tests to measure the fasting blood glucose levels and the levels after administration of 100 g of glucose. The blood glucose levels need to be within limits to prevent the baby from being born overweight; with some underlying disorder or reduction in the growth of the baby. 

If one is diagnosed to suffer from GD, the doctor may advise her to follow a proper planned diet, perform some minor exercises everyday and insulin in some selected cases. These steps are generally sufficient to control the blood glucose level and prevent complications to the baby. The doctor may also advice to undergo some tests to confirm that the baby is growing normally. Gestational diabetes usually resolves after delivery and may not be required to continue taking insulin. However, she may be at risk of developing diabetes at a later stage in life and hence need to maintain the weight.10 The doctor will advice about these risks and the methods to avoid them. 

Gestational Hypertension

One of the important changes in a pregnant woman’s body during pregnancy is variation in the blood pressure. Severe alterations may be dangerous both for the mother and the baby. Some women who were normal before suffer from increased blood pressure that is noticed for the first time during pregnancy. This is termed as gestational hypertension. This is generally a transient condition, which generally normalizes by 6 weeks after delivery. The condition which occurs during the second half of the pregnancy is generally diagnosed during routine check ups.11 Doctors may prescribe certain medications, if they feel that the blood pressure is high enough to cause problems to the mother and the growing baby. These medications are usually discontinued after the blood pressure returns to normal levels. Always follow the instructions from the doctor if one is diagnosed to suffer from gestational hypertension.

Diseases during pregnancy

STDs during pregnancy

Labor and Delivery

Labor refers to a series of rhythmic, progressive contractions of the uterus that help the baby to begin moving towards the birth canal (vagina) and then outside the mother’s body through vagina. This is the last stage of pregnancy after which the mother can see the much awaited baby!

The labor is divided into three stages during which the baby gradually moves from the uterus (where it has reached the complete growth) towards the exit through the birth canal and then outside. The initial phase which is signified by continuous regular contractions lasts for about 5–12 h, followed by an active phase for about 2–3 h. The second stage lasts for about 45–60 min during which the baby can be delivered. The mother may be asked to push the baby out by bearing down during each contraction, until the baby is born. This may require some effort! But all this effort is replaced by joy as the mother hear the baby’s cry! During the third stage, the tissue that connects the mother to the baby (placenta) is delivered as the uterus begins to contract. This stage lasts from a few minutes to about 20 min.12

Contractions in the lower abdomen at regular intervals and back pain are generally the first signs of labor. Other signs that may also be indicative include a small discharge of blood mixed with mucus from the vagina (“bloody show”) or the occasional rupture of the fluid-filled membranes that contain the fetus (amniotic sac), commonly described as “the water breaks”. One should notify the doctor immediately when she experiences these signs and should be hospitalized for delivery.12,13

If signs of labor are not observed near the due date as predicted by the doctor it may need to be induced by the administration of certain medications. These medications induce contractions in the uterus thereby facilitating labor.

Most women can deliver their babies through the vagina which is commonly referred to as a normal delivery. Medications that may be administered during labor include pain relieving agents (analgesics).13 This helps in reducing the stress felt by the mother during pregnancy. The vagina may at times be needed to cut to a small extent to facilitate easier delivery. This cut is stitched after delivery.14

Labor and delivery

Cesarean section or the C-section

Cesarean section or the C-section is the method of delivering the baby by making a cut (incision) through the abdomen and the uterus. This method of delivery may be advised based on numerous factors such as the position of the baby in the uterus, size of the baby, number of babies, opening of the cervix during labor, health status of the baby and the mother.13 This is a surgical procedure, which is done under anesthesia. The baby is delivered through the incision made and the uterus will be closed with specialized stitches that will dissolve in the body over a period of time. The mother may be advised to stay in the hospital for 2–3 days following the C-section procedure. The stitches and the wound in the abdomen require a few weeks to heal during which she should not perform any strenuous works. The doctor will advice about the various precautions and measures to be taken following this procedure.15

Cesarean section

Breastfeeding

Breastfeeding the baby is one of the most special times in the mother’s life wherein a special bondage develops between the mother and the baby. The breast-milk provides complete nutrition required the baby during its early growth and also helps the baby to develop immunity against various infections.

Other reasons why breastfeeding is good for the baby include:

  • The colostrum (a yellow, watery pre-milk) that is secreted from the breast for the first few days after delivery helps the baby’s digestive system grow and function efficiently.
  • The protein and fat in breast milk are more easily available for the baby’s body.

Breastfeeding is good for the mother also! It offers various advantages such as:

  • It is always available and at the right temperature and convenient to feed r baby.
  • The process results in the release of a hormone known as oxytocin, which helps the uterus to contract and return to its normal size more quickly.
  • The risk of osteoporosis and some forms of cancer is low in women who breast feed.
  • It may help the mother lose the weight faster, which is gained during pregnancy.16

Method of Breastfeeding

Always the mother should find a comfortable place and position to feed the baby. A sitting position with holding the baby comfortably is usually ideal. At night the mother can feed the baby by lying on her side. This position is also advised for mothers who had a Cesarean section.

Hold the breast in a hand and gently stroke the baby’s lower lip with the nipple and bring the baby close to r breast as it starts to open the mouth. The baby generally sucks the milk in a smooth and even manner and can hear him or her swallow the milk. A slight tugging sensation may be felt while the baby is having the milk. Slight discomfort may be felt for the first few days while nursing the baby. The mother may feed the baby about 8–12 times in 24 h as and when the baby feels hungry. She can offer one breast at a time for complete feeding, and she is required to maintain a healthy diet in order to maintain her health and also keep the baby healthy. Consult the doctor if any changes in the feeding pattern of the baby has been noticed or felt the baby is not getting enough milk.

Some women may face problems such as engorgement of the breasts, sore nipples, blocked ducts or infection of the breast (mastitis) in some rare instances. Consult the doctor if one face any signs like fever that may or may not be associated with pain, bleeding, rashes, lumps or redness in the breasts. These are minor complications which can be eliminated completely with proper care.

Termination of pregnancy

Medical termination of pregnancy

Emotionally cope up with the traumatic event of termination of pregnancy

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References

1. Jabbour HN, Kelly RW, Fraser HM, Critchley HO. Endocrine regulation of menstruation. Endocr Rev 2006; 27(1):17–46.

2. Khan-Sabir N, Carr BR. The Normal Menstrual Cycle and the Control of Ovulation [homepage on the Internet]. MDText.com, Inc.; c2005 [updated 2005 March; cited 2007 Feb 15]. Available at: http://www.endotext.org/female/female3/female3.htm

3. Padubidri VG, Daftary SN (eds). Shaw’s Textbook of Gynaecology. New Delhi: Elselvier, 2004.

4. NICHD, Pregnancy [homepage on the internet]. Rockville, MD; Department of Health and Human Services. [updated: 2007 Jan 15; cited: 2007 Dec 18]. Available at: http://www.nichd.nih.gov/health/topics/pregnancy.cfm

5. Center for Devices and Radiological Health, Home-Use Tests – Pregnancy [homepage on the internet]. US Food and Drug Administration. [updated: 2003 Feb 01; cited: 2007 Dec 18]. Available at: http://www.fda.gov/cdrh/oivd/homeuse-pregnancy.html#info

6. England MA. Life before Birth, 2nd edn. London: Mosby-Wolfe, 1996.

7. Moore KL, Persaud TVN (eds). The Developing Human: Clinically Oriented Embryology, 7th edn.  Philadelphia: Saunders, 2003.

8. Quinla JD, Hill DA. Nausea and vomiting of pregnancy. Am Fam Physician. 2003; 68(1):121–8.

9. Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest. 2005;115(3):485–491.

10 .Bottalico JN.Diabetes in pregnancy. JAOA. 2001; 101(2): S10–S13.

11. James PR, Nelson-Piercy C. Management of hypertension before, during, and after pregnancy. Heart 2004;90:1499–1504.

12. The Merck Manual of Medical of Medical Information. Labour. [homepage on the internet]. Whitehouse Station, NJ: Merck & Co., Inc.; [updated 2003 Feb; cited 2007 Dec 18]. Available at: http://0-www.merck.com.mill1.sjlibrary.org/mmhe/sec22/ch260/ch260b.html

13. The American College of Obstetricians and Gynecologists.  and your baby: Prenatal care, labor and delivery and post. [homepage on the internet]. Washington, DC: ACOG; [updated 2007 Jan; cited 2007 Dec 18]. Available at: http://www.acog.org/publications/patient_education/ab005.cfm

14. The Merck Manual of Medical of Medical Information. Labor and Delivery Procedures. [homepage on the internet]. Whitehouse Station, NJ: Merck & Co., Inc.; [updated 2003 Feb; cited 2007 Dec 18]. Available at: http://0-www.merck.com.mill1.sjlibrary.org/mmhe/sec22/ch261/ch261e.html

15. The American College of Obstetricians and Gynecologists. Cesarean Birth. [homepage on the internet]. Washington, DC: ACOG; [updated 2005 Jan; cited 2007 Dec 18]. Available at: http://www.acog.org/publications/patient_education/bp006.cfm

16. The American College of Obstetricians and Gynecologists. Breastfeeding your baby. [homepage on the internet]. Washington, DC: ACOG; [updated 2001 July; cited 2007 Dec 18]. Available at: http://www.acog.org/publications/patient_education/bp029.cfm

Written by: healthplus24.com team

Date last updated: December 12, 2014