Chronicle Editor
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Pregnancy can cause a lot of anxiety especially with first pregnancy.
The mother’s body undergoes many changes during pregnancy that ensure growing baby’s (foetal) breathing, nutrition and excretion as well as protecting the mother at birth.
The aim of antenatal care is to promote the well-being of the mother and her developing baby, to monitor the pregnancy and identify any problems so that appropriate action can be taken.
Antenatal care includes providing information, advice and reassurance about pregnancy, childbirth, and motherhood as well as monitoring, screening and treating problems where necessary.
The guideline for routine antenatal care recommends 10 scheduled appointments for first pregnancy women and seven for women with an uncomplicated pregnancy history.
The first appointment in pregnancy should be early (before 12 weeks’ gestation) so that women can be provided with information to allow them to make decisions about a range of issues, including the pattern of care they wish to receive, choices about antenatal screening and early discussions about planned place of birth.
Women can also be provided with information on their lifestyle which help to optimise their health during pregnancy, eg diet, exercise, smoking, drugs, alcohol and working patterns.
Most women can be reassured it is safe to continue working during pregnancy.
Exercise started or maintained in pregnancy has not been associated with any adverse outcome.
Women should avoid potentially dangerous activities, especially those that can result in stomach injury.
Physically demanding work and prolonged standing is associated with poor pregnancy outcomes.
Pregnant women and their employers should assess the significance of this risk and adjust occupational exposure accordingly during the pregnancy.
Sexual intercourse in pregnancy is not known to be associated with any adverse outcomes.
Common problems in pregnancy are nausea and vomiting which are worse in the 1st trimester, its more common in early pregnancy and can be worse in multiple pregnancy (like twins).
Usually needs reassurance, however, ginger can reduce severity.
Heartburn: burning sensation or discomfort felt behind the sternum (lower anterior chest) or throat or both can occur.
Maintaining an upright posture especially after meals, eating small frequent meals, avoiding irritants such as caffeine or other trigger foods can assist.
Safe first line treatments include Gaviscon® or magnesium trisilicate.
Delayed stomach emptying predisposes to indigestion and constipation.
Constipation in pregnancy is made worse with iron supplements.
High fibre content in the diet is frequently effective and treatment with laxatives is best avoided.
There is an increased demand for iron and folate by the growing baby, which means the mother may need to supplement using tablets.
This reduces the risk of back defects in the growing foetus.
Few complementary therapies have been shown to be safe and beneficial in pregnancy but some herbal therapies have been found to be toxic.
Usually, a balanced diet will suffice.
Excess alcohol in pregnancy has an adverse effect on the foetus, including low birth weight, learning difficulties or, with heavy and prolonged drinking, foetal alcohol syndrome.
The advice is to limit alcohol intake to no more than 1-2 units per week.
One unit of alcohol is a single measure of spirit, one small glass of wine, half a pint of regular strength beer, lager or cider.
Smoking is associated with adverse pregnancy and prenatal outcomes; Women should be encouraged to stop or reduce smoking.
Women should be discouraged from using cannabis or other illicit drugs.
As the womb grows it starts to compress blood vessels in the pelvis which may cause dizziness and at times may lead to fainting/collapsing and nausea.
Pregnant women especially from the 2nd trimester going forward are encouraged to lie on their left side so as to reduce pressure on the pelvic blood vessels.
Increase in vaginal discharge is normal change in pregnancy.
Further investigation is warranted if it is associated with a strong smell, soreness, itching when passing on urine.
Urinary stasis (holding urine) predisposes to urinary tract infections, these usually present with pain on passing urine, increased frequency of passing urine and pelvic pain.
Increased water intake will help reduce the risk of urinary tract infections.
Close follow up and monitoring is required for mothers with:
l Pre-existing medical conditions like hypertension, diabetes, epilepsy or psychiatric disorder cancer, HIV,
l Age under 18 years or over 40 years,
l Previous operations like Caesarean Section or uterine surgery, for example myomectomy,
l Three or more miscarriages under 12 weeks,
l Previous pre-term birth or mid-trimester loss,
l Previous baby with birth defects,
l Previous baby 2,5kg or 4kg at term.
The nine-month duration of pregnancy is divided into equal 3-month stages termed trimesters.
Initial ultrasound scan is recommended in the first trimester as it helps determine if the pregnancy is sitting well in the uterus and for estimation of accurate expected dates.
Offer ultrasound screening for any structural abnormalities at about 20 weeks.
If there are no other complications, there will be no need for further scan at a later stage.
Till next week stay safe.
l Dr Tatenda Simango can be contacted on [email protected] or follow him on Facebook@ 9th Avenue Surgery.
Online Reporter