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Showing posts with label Prenatal Care. Show all posts
Showing posts with label Prenatal Care. Show all posts
Friday, October 17, 2008
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Sex Life During Pregnancy



Description

Early in pregnancy (less than 12 weeks), the changes in libido are diverse. Because of individual differences, sexual desire may increase or decrease. But, during the middle stages of pregnancy, libido generally increases, when most of the early discomforts are relieved -- aside from the larger stomach -- and the mother adjusts to being pregnant. The breasts still feel inflated but breast pain, mammaglia, is mostly alleviated. After about 19 weeks, preparations for breast-feeding are complete, and stimulation of the breasts may cause foremilk to be secreted. Because blood vessels inside the vagina become more abundant and cause the vagina to swell easily, a vaginal lubricant may be used if sex is awkward and uncomfortable.



After 20 weeks, as the top of the uterus reaches the belly button, the lower stomach begins to bulge out. The stomach grows quickly and the shape of the body changes. During intercourse, a position that doesn't put pressure on the stomach is recommended. At this time, mothers with a high risk of premature birth and mothers diagnosed with placenta previa must refrain from intercourse. Mothers with serious illnesses like gestosis should avoid orgasm because of the rise in blood pressure (systolic, a 30-80 mm Hg rise; diastolic, a 20-40 mm Hg rise). As the last month approaches, the top of the uterus reaches the precordium. The cervix descends and becomes soft enough that even light contact can cause bleeding. There is some disagreement over how long it is safe to continue having intercourse. Some scholars, fearing infection, argue that during the last 2 months a couple should practice abstinence, but others argue that as long as a condom is used, intercourse is fine. Generally, a large majority of couples control their sex lives as the last month approaches. Actually, intercourse and the uterine contractions that accompany orgasm do not induce labor or harm the baby. During the last month, the birth canal should be kept clean without infection, and one must consider the mother's physical discomfort. Spending this time wisely, with plenty of conversation, is advisable.


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Pregnancy Over-the-counter Tests



Description

The following is a discussion of the general signs and symptoms of pregnancy, and of the current methods of diagnosis using inexpensive over-the-counter tests.



Changes in the body due to pregnancy

Many changes occur in the woman's body as a result of pregnancy, the most notable of which is the cessation of the menstrual cycle. Thus, a missed period can serve as a preliminary indicator of pregnancy for women with regular cycles; however, for women with irregular ones, it may not be as reliable. The all too familiar indicators of pregnancy, nausea and vomiting (hyperemesis), are also very important changes. Hyperemesis, which is a result of the hormonal changes in the body, begins around the 6th week of pregnancy and lasts until anywhere from the 12th to the 18th week. In most cases, hyperemesis goes away without treatment, but in rare cases when the symptoms are extreme and occur along with weight loss and dehydration, hospitalization may be required for reintroduction of bodily fluids. Other symptoms, such as changes in the breasts or skin pigmentation, may appear but they may not be that apparent in the early stages of pregnancy. Other early symptoms are fatigue and frequent urination. Although these are not the most representative indications of pregnancy, when they do occur, further testing is advised for a timely diagnosis.


How is pregnancy diagnosed?

Due to the advancement of medical technology and diagnostic tools, a woman can easily and accurately perform a pregnancy test. Only a few drops of urine are needed for most over-the-counter pregnancy tests. The sensitivity of the tests is so good that a pregnancy can be detected as early as the 4th (2 weeks after fertilization). However, it must be kept in mind that these tests only give a "yes" or "no" answer and tell us nothing about the state or condition of the pregnancy. For example, a pregnancy outside the uterus (extrauterine pregnancy), a miscarriage, or a hydatidiform mole can give false-positive results. Therefore, it is very important that a follow-up checkup be made with an obstetrician/gynecologist to confirm the normalcy of the pregnancy. Ultrasound is a very powerful and effective diagnostic tool in today's ob/gyn clinics and offers us a better look into the womb. A pregnancy can also be confirmed with a pelvic ultrasound after only 5-6 weeks and the embryonic sac can be observed after 4-5 weeks with a vaginal ultrasound. Other diagnostic tools, such as the level of HCG hormone level in the blood, can tell us much about the growth of the fetus in the womb, as well.

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Pregnancy and Working



Provided a woman does not experience fatigue or exhaustion, working during pregnancy is acceptable. However, work that requires a lot of strength or exerts pressure on the lower abdomen is not advisable; lifting and moving heavy objects, walking up and down stairs, or sitting for long periods is also not recommended.



Working can continue as long as it is reasonable and not exhausting. If a woman's job requires a lot of standing, she should elevate her feet and rest during breaks. Efforts should be made to avoid workplace chemicals and other toxic substances during pregnancy.

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Pregnancy and Travel



Description

# Women should refrain from traveling or taking long trips during the latter half of a pregnancy. If it cannot be avoided, planes and trains are the most comfortable and least exhausting ways to travel long distances. Most airlines, however, will not allow women who are more than 36 weeks pregnant to board flights. Moreover, it is not advisable for pregnant women to fly at high altitudes under low atmospheric pressure.



If travel involves a lot of walking, a woman should rest 15 minutes for every 2 hours walked. Take extra precautions when traveling by sea, and be aware of the increase in dangers, such as infections or dysentery, when traveling to a foreign country.
# When traveling by car, stop every 2 hours and walk or stretch for 15 minutes.
# If travel is necessary, choose a train over a bus, and avoid traveling in cars with heavy vibrations.
# If at all possible, refrain from traveling during the second and third months, and toward the end of the last trimester, when miscarriages are most likely to occur.


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Pregnancy and Medication



Description

There have been instances of women, fearful of fetal deformities, who sought curettage or abortion because they took cold medicine early in their pregnancy. Because so many drugs can be taken without consulting a doctor-anti-emetics (control nausea and vomiting), antacids, antihistamines, analgesics, antibacterial agents, anti-hypertension drugs, diuretics, and even neuropsychiatric drugs-it is not uncommon for women to unwittingly take medications early in a pregnancy. Luckily, most medicines do not affect babies seriously. Pregnancy can be divided into the ovular stage (from fertilization to implantation), the embryonal stage (2nd week to 8th week), and the fetal period (7th week to term). Of these stages, the embryonal stage is considered to be the most sensitive and dangerous because this is when organogenesis (organ formation) takes place. Only a few drugs are known to cause fetal deformation, and usually these drugs do not cause fetal deformities when administered during the embryonal stage or other periods.



. Medicine Use Effect on fetus
Medicines that should not be used Cloroquine Malaria Ocular abnormalities
. Heroin Drug abuse Hypoventilation and withdrawal symptoms after delivery
. Live vaccine (measles, rubella, etc.) Immunity Possible deformation from viral infection
. Smoking (nicotine) Epilepsy Hinders fetal development, affects intelligence
. Alcohol . Fetal deformation, retardation, ateliosis
. Trimethadione Epilepsy Fetal deformation, retardation, developmental disturbance
. Anticancer drugs . Fetal deformation
. Valproic acid Epilepsy Nervous system abnormalities (spondylolysis)
Medicines that can be used for basic treatment Anticoagulant drugs Venous blood disease Separation of the placenta, fetal bleeding
. Antithyroid drugs Thyrotoxicosis Goiter, struma
. Barbiturate Epilepsy, to calm Withdrawal symptoms after delivery (rare)
. corticosteroid Diverse purposes Cleft palate (not proven)
. Insulin Diabetes Glycopenia
. Progesterone derivatives Imminent abortion Possibility of girls changing to boys (rare)
. Laxatives Diarrhea treatment Possible premature birth
Medicines to avoid Streptomycin Bacterial infection Deafness


Medication known to cause deformation

ACE inhibitor: ingredient of high blood pressure medication
Alcohol: well known
Androgen: A male hormone; women rarely take it, but it is sometimes used, like Danazol, to treat endometriosis, and breast cancer, and to prevent mastodynia.
Carbamazepine: used to treat epilepsy and neuropsychiatric disorders
Coumarin: an anticoagulant
Cyclophosphamide: an anticancer drug
Danazol: contains androgen
Diethylstilbesterol: a female hormone used in the past, but no longer used because it causes fatal deformations and cancer
Etretinate: a synthetic vitamin A used to treat acne
Isotretinate: acne treatment
Lithium: neuropsychiatric drug used to treat manic-depression
Methimazole: used to improve thyroid gland function
Methtrexate: an anticancer drug
Phenytoin: neurological and neuropsychiatric drug
Tetracycline: A type of antibiotic, when taken during pregnancy, causes coloration of the baby's teeth.
Trimethadione: epilepsy medicine
Valproic acid: epilepsy medication
Also, Aminopterine, Chlorbiphenyls



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Pregnancy and Disease



Description

The following is a discussion of the primary diseases and conditions associated with pregnancy. (It is not intended to be definitive).



Uterine myoma

# The uterus is made of hard and strong muscle. A uterine myoma is a hard benign growth that forms on this muscle layer. Most myomas form on the corpus uteri, but occasionally they form around the cervical duct. Myomas are not found in teenagers, but the incidence rate increases with age as women enter their 20s, 30s, and 40s. The rate also increases among women who have pregnancies later in life, or women who had an uneventful first pregnancy, but whose second pregnancy is marked by the discovery of a myoma.
# A myoma can be a cause of infertility in women who previously had a successful pregnancy but several years later are unable to conceive. If the myoma interferes with conception, a myomectomy is performed. Many women do become pregnant after this surgery.
# Usually, a myoma will not interfere with a pregnancy; as the fact that a woman is pregnant with a myoma, means that the myoma is small. Generally, when a myoma becomes larger, the amount of menstruation increases and cramps become severe. This is especially true in the case of myoma uteri submucosa, myomas that form on the inside of the uterus. This type of myoma can cause infertility or miscarriage.
# If a woman is somehow pregnant and a large myoma is present, the myoma can cause abnormalities with the position of the fetus. Normally after 30 weeks into pregnancy, the fetus is positioned head down, but if a myoma interferes, the baby can be reversed. This can be detected early using ultrasound. Although the placenta and fetus may be in normal positions, a cesarean section is done if a myoma interferes with natural birth.


Ovarian cysts

Sometimes it is discovered during early prenatal examinations that the ovaries are swollen. But most of the time this indicates a luteal cyst. Despite the presence of a luteal cyst, the ovaries almost never grow larger than 6 cm, and around the 4th month when the placenta is complete, the cyst should shrink. No special treatment is necessary when a luteal cyst is diagnosed by ultrasound or other methods.

# Surgery is only necessary when a cyst grows larger than 6 cm, and when complications like torsion or rupture occur.
# Surgery does not affect the baby.

After the 4th month, when the placenta is complete, the problematic ovary is removed. By this time, hormones needed to continue pregnancy are secreted from the placenta. After childbirth, ovulation occurs regularly every month so pregnancy is possible again. Generally, surgery does not cause miscarriages or premature births.


Endometriosis

The endometrium is the layer covering the inside of the uterus. Endometriosis is when similar tissue to the endometrium forms inside the uterine muscle, outside or behind the uterus, or inside ovaries. The cause is unknown. The symptoms vary depending on where it occurs, but generally cramps and menstrual irregularity accompany it. If endometriosis is severe, organs can adhere inside the pelvis and cause infertility. But pregnancy indicates that the symptoms are light. If it is severe enough to affect pregnancy, the affected part of the ovary can be surgically removed. Surgery can be done during pregnancy without the danger of miscarriage and premature birth.
# Symptoms may become lighter with pregnancy


Uterine cancer

# Different measures can be taken depending on whether children are wanted or not.
# There are 2 types of uterine cancer-uterine body cancer and uterine cervical cancer. With uterine body cancer, pregnancy is impossible; but with uterine cervical cancer, it is possible. Uterocervical (cervix) cancer has almost no subjective symptoms in the early stages, so early detection is difficult unless examined. If it is discovered before it becomes cancerous, it can be treated by operating on the cervix or by laser irradiation. A decision must be made to delay surgery (of course, depending on the severity of the cancer) if a child is wanted, or go in to surgery immediately for the mother's future.
# Uterine cancer can be confined to the endometrium or invasive, which has a very low survival rate. (See detailed sections on uterine cancer.)


Vaginitis

Normally infection and inflammation do not occur easily inside the vagina because it is acidic, but pregnancy changes vaginal flora and candida or Trichomonas can easily cause vaginitis. With candida vaginitis, there is an increase in cheese-like mucous and itching around the pudendum. With Trichomonas vaginitis, there is an increase in yellow, puss-like mucous with foaming and itching around the pudendum, and burning pain.


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Physical Changes during pregnancy



Description

# The following discussion addresses some of the changes and issues experienced by expecting mother during early pregnancy (1st trimester, 1 month - 3 months).



# Physical changes

# Basal body temperature continues to be high for more than 2 weeks.
# Amenorrhea
# Nipples become colorized.
# Breasts grow larger and feel inflated.
# Frequent urination
# Increase in vaginal secretions
# Morning sickness
# Emotions become sensitive.


Attention

# The placenta is not completely formed, and there's a danger of miscarriage, so refrain from immoderate exercise and long travel.
# If there's morning sickness, eat smaller portions often. Usually morning sickness goes away by the 3rd month. If it continues and is severe, consult a doctor.
# To prevent constipation, eat plenty of fruits and vegetables, and try to make it a habit to go to the bathroom at a set time every day.
# Bad teeth can get worse with pregnancy. Receive a checkup ahead of time to prevent teeth from getting worse.
# Rather than tight clothes, wear loose clothes that are comfortable to move in.
# When mothers suffer from diseases such as rubella (German measles), there's the danger of the baby being affected and deformed. Receive a general medical examination.
# When taking medication, consult a doctor.
# Prevent infection by avoiding crowded areas.


Middle period of pregnancy (2nd trimester, 4 months - 7 months)


Physical changes

# A relatively safe time and small chance of miscarriage
# Around the 5th month, fetal movement is felt.
# Increased appetite and body weight
# Lower abdomen and breasts grow gradually.
# When standing, the upper body begins to tilt back.
# Emotions become sensitive


Attention

# As the fetus grows, more nutrients are needed. Eat plenty of nutritious and well-balanced meals.
# Pay attention to blood circulation, because it may be disrupted as the fetus grows, causing hemorrhoids and bloodshot veins in the legs.
# In the 7th month, receive an examination to check the baby's position, and be cautious of fever and pain from urinary tract infection, which may be related to gestosis.
# It becomes harder to balance the body as the fetus grows, so wear comfortable low-heel shoes. Vaginal bleeding during this period may be related to abnormalities with the placenta, so consult a doctor immediately.


Late pregnancy (3rd trimester, 8 months - 10 months)


Physical changes

# Abdominal striae appear
# May develop edema in the legs
# Frequent urination
# Occasionally, toward the end of pregnancy, there's secretion with a little blood. This is a sign that labor will begin within days.


Attention

# During the 8th and 9th month, receive examinations every 2 weeks, and during the last month receive an examination every week so that there is time for treatment.
# Eat healthfully and be prepared to deliver at anytime.
# Beginning in the 8th month, wash breasts with lukewarm water every morning and evening, and afterwards rub the nipples and the surrounding area with a dry towel. When the nipples are depressed (inverted nipples), they can interfere with breast-feeding, so consult a doctor and receive treatment.
# Don't be anxious about delivery, and look to an expert for guidance.
# Refrain from sexual relations toward the end of pregnancy, especially the last month.
# Refrain from excessive sports and exercise, which can cause premature birth and edema.

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Obstetrical Case History Management



Description

In order for the physician to insure the health and safety of mother and fetus, a comprehensive history of the mother's past pregnancies, gynecological history, sex and contraceptive history, and vaginal exam will be necessary.



Obstetrical case history

# During the initial prenatal examination, the physician will ask about and the woman should be prepared to discuss past delivery dates, delivery methods, term of pregnancy, labor duration, body weight at the time of delivery, and complications and diseases related to pregnancy. Complications-and the illnesses caused by such complications-that occurred in earlier pregnancies can return with subsequent pregnancies. If a woman has delivered a baby over 4 kg, a screening for gestational diabetes is conducted between the 24th and 28th week of pregnancy. Patients who had a cesarean section are candidates for vaginal deliveries, and this should be discussed at the prenatal examination.
# If the mother has delivered a baby with congenital deformation, or has experienced the death of a fetus or infant, genetic counseling and prenatal observation of the fetus are needed.


Gynecological case history

# It is essential to know exactly what day the last menstruation occurred. Based on a 28-day cycle, patients using oral contraceptives may need correction. Predicting the expected date of confinement from an accurate date of the last day of menstruation, along with vaginal examination findings from early in the pregnancy, is just as accurate as using ultrasound. A history of sexually transmitted diseases (STDs) increases the risk of extrauterine pregnancy, fetal infection, and premature birth.
# Contraceptive method: If pregnancy occurs while using an intrauterine device, that device must, of course, be removed, and patients using oral contraceptives need to correct their expected date of delivery.
# A case history of infertility increases the risk of extrauterine pregnancy, miscarriage, and other serious possibilities.
# Patients who have had uterine surgery have a greater chance of receiving a cesarean section, and patients who have had abdominal surgery have a higher chance of complications such as extrauterine pregnancy.


Vaginal examination findings

# External genitalia: the existence of STDs, vaginal secretion, observation of scars from past deliveries
# Cervix: whether it should be enlarged or reduced early, abnormal secretion, whether or not cyanosis exists
# Uterine body: size, hardness, pressure pain, whether the shape is abnormal (bicornate uterus), presence of fibroids and fetal heart sound, and size and position of fetus
# Uterine appendages: observe for abnormal mass and pressure pain


Case history related to sex life and contraception

# Sex life: current partner, method, and level of satisfaction are recorded.
# Contraception: questions are asked about the method of contraception and what kind of contraceptives will be used after delivery.
# The woman must be asked about any sexual assault or abuse in the past.

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Managing Chronic Diseases During Pregnancy



Description

Clinicians should monitor diseases that can get worse with pregnancy (examples: systemic lupus erythematosus, asthma, sickle cell disease, rheumatic heart disease, bleeding disorders, etc.).

1. Prenatal monitoring, as well as genetic counseling, is needed if a family history of congenital deformities or chromosome abnormalities exists.
2. Ask about family history of diabetes and high blood pressure.
3. Ask if the patient has or had been exposed to infectious diseases, like tuberculosis, hepatitis, or acquired-immune deficiency syndrome.
4. The likelihood of multiple pregnancy increases if there is a family history of multiple pregnancy.



Heart disease

The burden on the heart increases with pregnancy. After the second trimester, women frequently notice shortness of breath and faster heartbeat. This is because the amount of blood and heart activity increases 30-50% at weeks 28-32. After that, it becomes temporarily comfortable, but it increases again at delivery, and then returns to normal 10-14 days later. In the case of rheumatic and acquired heart disease, the mother may experience difficulty breathing. And because not enough oxygen is supplied to the fetus, fetal death or handicap can be caused by this lack of oxygen. Women with heart disease should consult an expert to determine if the severity of their heart disease will allow pregnancy and childbirth. The most difficult time for a pregnant woman with heart disease is around 28-36 weeks, when the fetus is positioned at the upper part of the stomach and applying pressure to the heart.


Nephritis

Pregnancy can affect urinary system diseases, burden the urinary system, and make existing diseases worse. Women with chronic nephritis experience a worsening of the disease with every pregnancy. Therefore, women with nephritis need to be assessed before getting pregnant. If the last incident of acute nephritis was more than 2 years ago, or if the disease has been stable and latent for more than 2 years, then it is possible to carry a pregnancy to full term; if the function of the kidneys becomes worse, the mother must consider giving up the pregnancy. Pregnancy has a profound effect on chronic nephritis. Although symptoms may be mild initially, the symptoms can become serious after the middle stage of pregnancy.


High blood pressure

Three types of high blood pressure occur as complications of pregnancy: essential hypertension (thought to be genetic) and high blood pressure from gestosis aftereffects and nephritis aftereffects. Essential hypertension does not cause blood pressure to rise substantially early in pregnancy and proteinuria and edema rarely occur, but during the latter half of pregnancy blood pressure becomes very high and tends to cause gestational toxicosis. This tendency becomes stronger with every pregnancy. Nephritis- or gestosis-related high blood pressure causes the blood pressure to rises as the pregnancy progresses and often causes severe proteinuria and edema. If blood pressure does not rise substantially with essential hypertension, the growth of the fetus may not be impacted greatly; however, nephritis- and gestosis-related high blood pressure impair the placenta's function, hindering fetal growth and causing immature infant birth, fetal death, or premature birth.



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Lifestyle Issues During Pregnancy



Description

Because of the unique demands and changes placed upon the expecting mother's body, health, and emotional well-being by pregnancy, various accommodations and lifestyle adaptions are advised. They are as follows.



Clothes

Clothes will feel small after about 4 months. Buy maternity dresses that are loose, and do not put pressure on the stomach. Choose undergarments that stretch well at the abdomen.


Undergarments

Girdles are not necessary, but maternity girdles support the lower back and ease back pain. Bras maintain the normal shape and form of breasts. Big cups, a support strap that extends to the armpits so that the entire chest area can be covered, and wide shoulder straps are ideal. Women who plan to breast-feeding, should purchase special bras for this in the latter part of their pregnancy.


Shoes

Shoes are important because posture changes during pregnancy. Because they protect the feet and maintain balance as the stomach grows and appearance changes, flat, low-heel shoes are recommended. Comfortable shoes help prevent fatigue, back pain, and leg pain.


Baths

The body sweats more during pregnancy. Take a daily bath to ease tension and become invigorated. Be careful not to lose your balance and fall. There is no harm in bathing every day or every other day for relaxation and hygiene, but bathing for long periods is not recommended. Because the genitals become unclean from increased vaginal secretions, it is a good idea to wash nightly with warm water in addition to a bath. However, it is not good for the mother to wash the inside of her vagina (i.e., douche).


Sitz Baths

Sitz baths are not recommended. Washing with soap during a daily bath or washing the genitals nightly with warm water in addition to a bath is adequate.


Breast Care

When bathing, wash nipples with clean and soft cloth.


Teeth

Brush in the morning and after every meal.


Sex During Pregnancy

Pressure on the stomach may be uncomfortable, but unless a doctor prohibits it or it is overly strenuous, a woman may engage in sex during pregnancy. (Caution: There may be a danger of miscarriage in the later part of the third trimester. Consult your physician.)


Medications

Consult a doctor before taking any kind of medication.


Smoking

It is harmful to the baby. Pregnant women must quit smoking and avoid second-hand smoke (possibility of low-birth weight infant) during their pregnancy.


Make-up

Manicures and make-up for conditioning are fine.


Exercise

Walking or light walking exercises strengthen the muscles used during labor. Plus, it is relaxing and maintains physical strength. Exercises such as bicycling, aerobics, and swimming should be modestly paced so to avoid placing an undo strain on the body. When swimming, always swim in warm water.


Travel

When traveling long distances, planes and trains are the most comfortable and least exhausting mode of transportation. When traveling by car, stop every 2 hours and stretch or walk for 10-15 minutes. Avoid traveling long distances near the end of the pregnancy.


Work

A woman can continue to work as long as the job is not strenuous and tiring. Elevate and rest the feet during breaks if a job requires a lot of standing. Avoid workplace chemicals and toxic materials while pregnant. Do not lift or move heavy objects.

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Genetic Counseling and Pregnancy



Description

Because of advances in medicine, especially in the field of genetic mapping, it is possible for many of the previous century and decades' most crippling congenital conditions to be identified before birth. This places parents in the unique position of being able to decide whether or not to abort before term-a weighty and uncomfortable burden of responsibility to be sure, fraught with ethical and religious issues. Nevertheless, it is science's gift and duty to be able to advise parents of the likely outcome of such genetic conditions, so that they can decide for themselves.



Indications for genetic counseling and testing

1. At the time of delivery if a defect is present, or if the mother is 35 years old or older.
2. Parents have reciprocal translocation.
3. Parents previously had a baby with a chromosome deformity or neural tube deficiency.
4. Danger of disease from recessive autosome or recessive X chromosome exists.
5. The mother has been exposed to deformity-causing substances.

# As with other diseases, the following rules apply if a genetic disorder is suspected. The doctor and patient must communicate truthfully during genetic counseling to meet all diagnostic objectives. The doctor performing the genetic counseling should provide information but should not suggest a specific course.
# First, to determine what genetic diseases are present within the family, the family's medical history, including cousins, must be reviewed. Spontaneous abortions, stillbirths, and newborns with deformities must be recorded. Drugs or medication used during and before pregnancy must also be recorded. If the mother is 35 or older, she must receive genetic counseling; if the father is 40 or older, the frequency of dominant mutations (e.g., achondroplasia) increases.
# Couples who have experienced abnormal births undergo emotional changes such as denial, anger, guilt, bargaining, and resolution. In the beginning, it is good to simply be supportive. After 4-6 weeks, and once the baby's guardians have accepted the facts, genetic counseling can begin.

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Fetal Undergrowth



Description

Fetal undergrowth has been defined as the group of newborns occupying less than 10% frequency of the body weight percentage. But recently, after considering the mother's race, number of deliveries, body weight, and height, about 20-60% of the less than 10% group babies are known to grow normally later. Babies with growth problems have a high chance of contracting such fetal diseases as fetal asphyxia, hypoglycemia, and hypothermia. The following are factors in causing fetal undergrowth in infants.



Description

# Family factor: if the mother's small in stature, and has a small skeletal structure, the infant can be small too, and this can't be seen as abnormal
# Insufficient nutrition of the mother: insufficient weight gain between 14-15 weeks and 30 weeks, and undernourishment are causes
# Mother's smoking, drinking, and drug abuse
# Fetal infection: the fetus was infected by bacteria, virus, or parasites in the uterus
# Congenital deformity
# Fetal bone disease
# Exposure to chemicals: cigarettes, alcohol, painkillers, drugs, etc.
# Blood vessel disease of the mother
# Chronic kidney disease
# Hypoxia: heart disease, alpine area
# Anemia of the mother
# Placenta and umbilical cord deformation
# Twins

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Expected Delivery Date



Description

When anticipating a baby's arrival, do not rely solely on the expected delivery date, as the baby will not necessarily be born on this date. The baby could be born up to 15 days earlier or later than the expected date and still be considered a regular delivery. The length of pregnancy, or how long the baby is inside the mother, is not fixed. Generally, the term of pregnancy begins on the last day of menstruation and ends 280 days later (28 days = 1 month, 10 months = 40 weeks).



Calculating the expected delivery date

# Month of delivery: Nine is added when the last menstruation was between January and March, and three is subtracted if it was between April and December.
# Day of delivery: Seven is added to the first day of the last period to calculate the expected delivery date.

# Example: o If Feb. 9 was the day of last period, 2 + 9 = 11 (the month), 9 + 7 = 16 (the day). The expected delivery date is Nov. 16.
o If Sept. 25 was the day of last period, 9 - 3 = 6 (the month), 25 + 7 = 32 (the day). The expected delivery date is July 2.

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Dangerous Symptoms During Pregnancy



Description

Pregnant women must know and learn a lot about such things as diet, rest, sleeping, changes in internal activity, exercise, drugs, and alcohol use during their pregnancies. But the following symptoms indicate danger and should not be forgotten throughout the pregnancy.



# Uterine bleeding
# Swollen face, arms, and legs
# Severe or continuous headache
# Vision that becomes dim or poor
# Stomach aches
# Continuous and severe vomiting
# Fever and chills
# Difficulty urinating
# Fluid (amniotic fluid) leaking from the uterus


Sunday, October 12, 2008
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Diet and Nutrition During Pregnancy



Description

# As the fetus grows, more calories are required proportionate to the fetus' growth. An effort should be made to eat a quantitatively as well as a qualitatively balanced diet. It is especially important to eat adequate amounts of food rich in protein, calcium, iron, and vitamins, which are necessary for the baby's growth and development.



# Nutrient-rich foods

# Protein (meat, fish, eggs, beans): milk, fish, tofu, beans, meat, eggs, cheese, and dried fish.
# Vitamins (vegetables, fruit): carrots, bananas, egg yolk, mushrooms, butter, apples, peaches, oranges, strawberries, tomatoes, watermelon, and other fruits, spinach, eggplant, onion, cucumber, lettuce, cabbage, radish, and other vegetables.
# Carbohydrates (grains, potatoes): rice, barley, potato, sweet potato, red beans, and bread (wheat, corn).
# Iron, calcium (milk, dairy goods, fish eaten with bones): milk, cheese, liver, sardines, shrimp, green vegetables, seaweed, and powdered milk.
# Fat (milk fat products): butter, peanuts, walnuts, margarine, and cooking oil.

Foods requiring caution

# Salt: Eat less salty foods while pregnant; too much salt can cause edema and gestosis.
# Coffee: Interferes with sleep and causes frequent urination.
# Cold foods: Cold food is better for morning sickness than warm food, but eating a lot of cold food at once can cause diarrhea.
# Spices: Peppers, mustard, ginger, and black pepper are not harmful in small amounts, but such spices should be avoided if the mother has gestosis.
# Alcoholic beverages: Negatively affect the fetus and should be avoided.
# Cigarettes: Negatively affect the supply of oxygen and nutrients to the fetus and can cause premature birth; smoking should cease during pregnancy.

Nutrition and the working woman

# Skipping breakfast and then eating out for lunch spells trouble. Wake up earlier and make an effort to eat breakfast. It is hard to have a balanced meal when eating out, and many restaurants serve foods that contain high concentrations of salt. A healthier alternative is to prepare a lunch. Dinner should also be prepared after considering the nutritional content of breakfast and lunch.

Nutrition During Pregnancy Introduction


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Pregnancy


Description

The following is a discussion of some of the issues surrounding pregnancy, including sperm, fertilization, and sex determination of the fetus.



The fate of sperm

Sperm that has been ejaculated in to the vagina has the ability to swim by moving its long tail. With help from such things as muscle movement or the biochemical condition of fallopian tube secretions, sperm reaches the fallopian tubes from the vagina through the uterus. An egg, after being ovulated, can only live 18-24 hours, but sperm has a longer lifespan than eggs. It can live for 48-72 hours after ejaculation. So fertilization takes place when an egg is in the fallopian tubes and sperm arrives, or when an egg enters the fallopian tubes while there is live sperm.


Fertilization

The amount of semen that is ejaculated is approximately 3 mL and contains approximately 300 million sperm. Sperm do not like an acidic environment. The inside of the vagina is generally acidic, so sperm look for neutral or alkaline environments. The uterine entrance is neutral only 2-3 days before ovulation, or there is an increase in weak alkaline mucous. So a lot of sperm gather around the uterocervical canal, which is around the uterine entrance. Some sperm pass through cervical mucous and the uterine cavity and swim at a speed of 3 mm per minute toward the fallopian tubes. It takes 2-3 hours for sperm to reach the fallopian tubes. Only 150-200 sperm make it past the uterocervical canal and arrive at the fallopian tubes. Then, usually, only one sperm couples with the egg. In order for fertilization to take place, sperm have to be at the fallopian tubes before the egg. Couples trying to get pregnant should have intercourse a little before the estimated ovulation period.



When the sex is decided

Sex chromosomes determine sex. The two types of sex chromosomes are x and y. An egg only has x chromosomes, but sperm has both types. If the egg fertilizes with a sperm with x chromosomes, it is a girl, and if it fertilizes with a y chromosome, it is a boy.


Fission and implantation of the zygote

From the moment of fertilization, a zygote grows, and begins migrating toward the fallopian tubes. A zygote must pass through a fallopian tube's very narrow passageway. If the passageway is narrowed because of chronic inflammation, a large zygote is unable to pass. If implantation occurs inside the fallopian tubes, it becomes an extrauterine pregnancy. During this period, the zygote undergoes repeated fissions and arrives at the uterus 3-4 days after fertilization. At this time the zygote fissions into 12-58 cells. After fission occurs again, there is a split between the part that grows to be the fetus and the part that becomes the umbilical cord, amniotic fluid, amnionic membrane, and other things that help the fetus grow. Around this time, the cells begin implanting in the uterine wall. Pregnancy has occurred.

How Pregnancy Happens



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Ectopic Pregnancy



Also known as

# Tubal pregnancy

Description

# An ectopic pregnancy is a pregnancy that develops outside the uterus. The ectopic site can be a fallopian tube, ovary, or anywhere in the abdominal cavity.
# An ectopic pregnancy is not viable and requires medical or surgical treatment.
# Approximately 1% of pregnancies are ectopic.



# Risk factors

# History of pelvic inflammatory disease
# Use of an intrauterine device for contraception
# History of infertility
# History of gonorrhea or chlamydia infection
# History of a ruptured appendix (appendix "burst" before surgery)
# History of a previous ectopic pregnancy
# History of tubal surgery


Symptoms

# Lower abdominal cramps
# Missed period or painful period
# Irregular vaginal bleeding or spotting
# Pelvic pain
# May have backache and shoulder pain
# Adnexal mass
# Positive pregnancy test


Diagnosis

# Blood tests
# Serum beta-HCG (pregnancy test) at lower level than expected for a normal pregnancy
# Imaging
# Ultrasound
# Laparascopy


Similar conditions

# Acute appendicitis
# Pelvic inflammatory disease
# Ovarian torsion
# Kidney stone


Treatment

# Surgical removal of ectopic pregnancy (by laparoscopy)
# Methotrexate - a medication that can be given in place of surgery, to expel an early ectopic pregnancy

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Clinical Tests During Pregnancy



Description

It's wise to receive medical examinations, consultations, and delivery preparations during pregnancy from a designated doctor, who is a specialist in obstetrics and gynecology. There are anatomical and physiological changes during pregnancy that, ideally, should be observed by the same physician throughout the pregnancy.



Number of medical examinations:

# Up to 7 months pregnant, once a month
# 8-9 months pregnant, twice a month
# 10th month (last month), once a week


Tests to receive during pregnancy

# Blood test for anemia: Mother must take hemopoietics if anemia is present; avoid blood transfusions as much as possible.
# Blood type test and Rh factor: If the mother is Rh-negative and the baby is Rh-positive, the extreme hemolysis of the fetus can cause miscarriage, premature birth, or stillbirth.
# Blood serum test: A type of syphilis test, it must be done early in the pregnancy; the fetus can die or be stillborn if the mother has syphilis; if discovered early and treated properly the mother and baby can recover.
# Hepatitis test: The baby can contract hepatitis from its mother; many times mothers do not know they have hepatitis and it is impossible to detect without a liver function test (antigen, antibody test). If the mother is positive, the infant is vaccinated right after delivery.
# Urine test: Important in determining gestosis, diabetes, urethritis, pyelonephritis, and nephritis.
# Ultrasound: Ultrasound uses ultrasonic waves, a type of sound, to project images on screens and take pictures. It is a very valuable equipment in modern obstetrics; the level of fetal growth and development, deformations, hydatidiform mole, multiple pregnancy, placenta previa, premature separation of the placenta, early detection of unhealthy pregnancy, position and size of the fetus, and the placenta's size and position can all be diagnosed accurately without exposure to x-rays and radiation.
# Triple mark test: The maternal blood serum triple mark test taken between the 15th and 22nd week can detect 60% of fetus with Down syndrome and 80% of those with neural defects, such as spinal bifida.
# Amniocentesis: This test collects amniotic fluid between the 15th and 22nd week of pregnancy and checks for abnormalities with fetal chromosomes.
# German measles test: Vaccinations for measles, mumps, and German measles (rubella) are given at 18 months of age. Women who were vaccinated but are not immune to rubella must be revaccinated, because if a woman gets infected less than 3 months into the pregnancy, then 60% of such fetuses have deformities such as, deafness, congenital heart disease, and cataracts. Twenty percent of women who become infected 4-7 months into their pregnancies give birth to infants with deformities. Babies are aborted when affected by rubella. Three months after receiving a rubella vaccination, a woman should get an immunity test to see if immunity has formed, and then try to conceive.
# Other tests: electronic heart monitor, pelvic measurement, pap smear, etc.

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