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Pre Pregnancy / Pregnancy Care

Pregnancy is an exciting time for any woman. If you are pregnant or preparing to get pregnant, it is essential to take special care of yourself so you and your baby will be healthy. Taking care before pregnancy and during pregnancy can improve the chances of a smooth pregnancy and having a healthy baby.

Pre-pregnancy care (Preconception care) is the care taken before getting pregnant. It focuses on improving the mother’s health before getting pregnant to increase the chances of having a healthy baby (fetus). The purpose of preconception care is to assess any potential risks to you and your baby and to treat any medical conditions you may have before conceiving.

Men also have an equal importance in preconception care, as they make up half of the genetic material required to develop the baby. Men also require preconception care to improve sperm health that increases the chance of conception and a healthy baby. Taking a healthy diet and supplements, regular exercise and maintaining a healthy weight are recommended for men as part of pre-pregnancy care.

Pregnancy care (antenatal care) is the care that a woman gets during pregnancy. Pregnancy care should be initiated as soon as possible after pregnancy is suspected. Pregnancy care is important for keeping both the mother and baby (fetus) healthy. Lack of antenatal care increases the chance of low-birth-weight babies and stillbirth.

Early Pregnancy Complications

The first trimester (first three months) is the most critical time in a pregnancy because all the major organs of the baby develop during this period. Some common complications during early pregnancy include:

• Bleeding

Vaginal bleeding or spotting is a common problem that can occur during the first trimester of pregnancy. In most cases, continuous bleeding without any known cause may lead to a miscarriage.

• Miscarriage

The spontaneous loss of pregnancy before the 24th week is referred to as a miscarriage or early pregnancy loss. The majority of miscarriages occur during the first three months of the pregnancy (first trimester). The chances of miscarriage are higher during the first trimester because of incompletely developed organ systems. Most miscarriages occur due to chromosomal abnormalities.

Vaginal bleeding, cramps or abdominal pain, and fluid or tissue coming from your vagina are signs that indicate miscarriage. Miscarriages often cannot be prevented in most cases, and treatment requires complete removal of pregnancy tissue from the uterus.

• Ectopic pregnancy

Ectopic pregnancy is a pregnancy that is not in the usual place within the uterus (womb) but develops outside the uterus. The most common place that ectopic pregnancy occurs is in the fallopian tube (in most cases) or rarely outside the uterus (cervix, ovary or abdominal cavity). Infection in the uterus (pelvic inflammatory disease), previous ectopic pregnancy, and previous pelvic surgery, are the common causes of ectopic pregnancy.

Vaginal bleeding, sharp or cramping pain in the stomach and abdomen, and low levels of hCG are the usual symptoms of ectopic pregnancy. Medical treatment may be an option. Ectopic pregnancy can result in rupture of the fallopian tube and is a life threatening medical emergency. In such cases, surgical intervention may also be necessary.

• Molar pregnancy

Abnormal growth or development of placental cells in the embryo is known as molar pregnancy. It is also referred to as gestational trophoblastic disease (GTD). Molar pregnancy is caused by chromosomal abnormalities in the sperm, egg, or both.

Vaginal bleeding, absence of fetal heart tone, high hCG levels, and the presence of grape-like clusters in the uterus seen by an ultrasound are the common signs of molar pregnancy. Treatment includes removal of the abnormal placenta.

Labour & Childbirth

Birthing, also called labour or parturition is the act or process of giving birth. Every woman’s labour is different, even from the first pregnancy to the next. The process of normal childbirth is categorised into 3 stages of labour:

• First stage

This stage commences with dilation and thinning of your cervix to allow the baby to reach the end of the birth canal. It is usually the longest part of the labour and is divided into early labour and active labour.




Early labour




In early labour your cervix may dilate and you may experience mild-to-moderate contractions lasting for 30 to 90 seconds. A thick, stringy, blood-tinged liquid may discharge through the vagina. The duration of early labour is unpredictable, it can be longer for your first delivery and shorter for subsequent deliveries.




Active labour




During active labour your cervix dilates more rapidly and the contractions are stronger, closer and may last longer. The transition phase is considered as the last part of the active labour.

• Second stage

This stage is the birth of your baby and usually lasts from a few minutes up to two hours depending on the position of the mother and the baby. During this stage your cervix is fully dilated and the uterine contractions become more frequent and you may feel a strong urge to push. With each contraction you may be encouraged to push to speed up the process. You may be asked to withhold some pushes to help prevent tearing. Delivery of the baby completes this stage.



• Third stage

During this stage the placenta, an organ connecting the uterine wall and the fetus, is expelled

Caesarean Section

Caesarean section, also called a C-section, is a non-vaginal delivery of a baby. It is a surgical procedure of delivering a baby through an incision made in the abdomen and in the uterus. Your doctor may decide to perform a C-section if your condition is unsafe to go for a vaginal birth. Most of the times, it may be done when unexpected complications arise during labour. Some of the conditions, for which your obstetrician may recommend caesarean delivery, include:

• - Twin or multiple pregnancy

• - Labour does not progress – The uterine contractions may not be enough to cause dilation of the cervix and allow the baby to move into the birth canal

• - Fetal complications – Umbilical cord compression or abnormal heart rate

• - Placental problems – The placenta may detach from the uterus before delivery, the condition is called placental abruption

• - Large-sized baby – The head of the baby may be large and the birth canal may be small comparatively to allow safe normal delivery

• - Abnormal presentation – Breech baby or baby is in an abnormal position

• - Maternal conditions and infections – Conditions such as maternal diabetes or maternal high blood pressure and maternal infections such as human immunodeficiency virus or herpes

• - Previous one or more CS

Breastfeeding

Breastfeeding provides your new-born baby with the nutrients required for healthy development and growth. The yellowish sticky breast milk called colostrum, produced at the end of pregnancy, is the most recommended and perfect food for the newborn. Breastfeeding should be initiated within the first hour of birth and continue for at least 6 months. It may be continued up to 2 years of age and beyond, along with suitable complementary foods.

Puerperium

Puerperium is the period beginning immediately after the birth of a child until the uterus returns to its normal size, usually 6 weeks in duration. During this time, the changes that a mother goes through during pregnancy, returns to the non-pregnant state. Some of the common changes that occur during the puerperium period include.

• - The vaginal wall regains its original tone but remains fragile for 1-2 weeks.

• - The uterus shrinks back to its normal size and position

• - The cardiovascular system reduces its load and starts pumping blood sufficient for the mother in the first 2 weeks.

• - The colour of lochia (vaginal discharge)is bright red on postpartum days 3-4, reddish-brown after day 3-10 and then turns yellow. However, it may become red again for a few days

• - Urine levels decrease and reach normal levels in 4 weeks.

• - The breasts enlarge with milk.

• - Normal activities can be started as soon as the mother feels ready.