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Pregnancy care : warning signs and worrisome conditions

During pregnancy many changes are happening in your body! This can put you at a constant stress and while your doctor will try to assuage your stress, they usually do not have enough time. It would probably help a great deal if you could understand what he/she considers important during pregnancy care. Therefore, here is a peek into your doctor’s mind!

Worrisome conditions in the 1st trimester

Non -uterine pregnancy

Most pregnancies develop in the uterus, where implantation of embryo happens and  the placenta forms. But, in some cases the implantation can happen in the uterine tubes. These pregnancy mostly rupture the tube and can lead to bleeding and complications. Therefore, your doctor would like to do an ultrasound to confirm that the pregnancy is in the uterus

Existing health concerns in the would be mother

If yours is a planned pregnancy and you got a pre-conception check up and doctor consult, that is great. But, if that’s not the case, your doctor would want to make sure that you do not have common conditions such as diabetes, high blood pressure, thyroid problems etc. or nutritional deficiencies such as anaemia etc. Therefore your doctor would like to do some blood and urine tests in the first trimester itself

Existing infections in mother or any drugs that she is taking can impact health of the baby, so tests are done for these

Would be mother’s habits

Smoking and drinking are harmful to the foetus. Especially, alcohol in early pregnancy can lead to foetal malformations whereas smoking increases changes of foetal loss

Health risk in foetus due to family history

Some diseases running in family can put the unborn baby at genetic risk of developing these. examples are muscular weakness disorders, blood disorders such as thalessemia or sickle cell anaemia. Therefore your doctor would want to take a history and run tests if necessary. Especially in Indians the hemogobinopathies are common and hemoglobin electrophoresis before or at 10-11 weeks of pregnancy is mostly good

another important factor is the blood group compatibility of mother and baby, which depends on blood groups of both parents. Therefore, your doctor would like to do blood grouping of one or both of you

Abortion or loss of baby

Chances of spontaneous abortion are highest in the 1st trimester. So, any blood loss through vagina, except mild spotting in very early pregnancy is a red flag. Especially if associated with cramp like pain of lower abdomen

Worrisome conditions in the 2nd trimester

It is the safest trimester of pregnancy. But in this trimester, the baby’s organ development  and  mother’s health  has to be watched for developing some complications in pregnancy. Read below:

Foetal screening for malformations

In late 1st trimester or early 2nd trimester (11 weeks to 13 weeks 6 days) the baby is screened for Down’s syndrome and a few other anamolies. It is a voluntary scan and some people decide not to go for it. But, we would recommend it, especially if the would be mother’s age is 30 years or more

Between 18-22 weeks of gestation, ultrasound scan called anamoly scan is done, which looks for organ system malformations including heart etc.

Gestational Diabetes Mellitus (GDM)

Usually the test for GDM is done at 24-28 weeks bacause in most women this is the time of onset of the condition. But your doctor may do one at 12 weeks if you are at high risk or follow up with one at 32 weeks as well

GDM can lead to too big baby and risk of complications in third trimester or at the time of delivery, so it has to be well controlled by diet, exercise and if needed drugs or insulin

Pre eclampsia

It is a symptom complex in which the mother develops high blood pressure, protein loss in urine and/or one of more of organ dysfunctions manifesting as new onset headache, pain in abdomen, blurring of vision or flashes or abnormal platelets, liver enzyme etc. Your doctor would check your BP and urine protein frequently starting from second trimester. If you develop any of the symptoms described above, be sure to discuss with your doctor

Abortion or preterm labour

Any blood or red discharge or crampy pain in abdomen which comes in waves with shorter duration of releif in between should raise a suspicion preterm labour and you should consult your doctor

GDM, fetal malformations, fetal growth retardation, pre eclampsia, fetal lie and normal delivery

Worrisome conditions in the 3rd trimester

Preterm labor and pre eclampsia are still concerns in 3rd trimester. In addition your doctor is interested in monitoring :

Adequate growth of baby

In the third trimester the baby grows a lot, your doctor would want to ensure that the rate of growth is alright by clinically examining you as well as ultrasound test as per need

Adequate movement of baby

In the 3rd trimester mothers are taught to monitor their baby’s movement inside the womb. In India doctors commonly advise the following

  • Absence of fetal movements for more than 24 hours is a red flag
  • Less than 10 movements in 12 hours on two successive days is a red flag
  • If there is any significant change in your baby’s movements, you should discuss with your doctor

Conditions which may hinder chances of normal delivery

Some conditions of placenta, position of the baby, mothers birth passage or others preclude chance of successful normal delivery, in which case your doctor would advise for an elective caesarian section. In addition, some emergency situations such as cord around the baby’s neck etc.

Be sure to discuss in detail if you are not sure about the need in elective caesarian cases but when in emergency, time is precious!

Ruling out infections of genital tract

These infections increase the chance of health problems in the bay, so your doctor would like to rule out any. It is usually done with urine tests at 36 weeks or more of pregnancy

Time of delivery

In the late third trimester (34 week onwards) your doctor will closely monitor your amnioti fluid to understand whether baby is getting adequate nutrition and accordingly decide about the time of delivery.

In general, doctors like to wait till 41 completed weeks for onset of normal labor, if mother and child have no complications. Beyond 41 weeks, most would like to induce labor or do some other intervention to get the baby out

But in some cases, they may advise delivery at 38 completed weeks or even 37 completed weeks by choice. Be sure to probe and understand the reason!

Warning signs in pregnancy

Lets now discuss what are the warning signs, that should prompt a discussion with your doctor or a visit

  1. Blood or red discharge through vagina along with crampy pain in lower abdomen (abortion is a big concern)
  2. In 1st trimester, pain in lower abdomen with feeling of dizziness with very slight blood or spotting through vagina (rupture of pregnancy developing outside uterus is big concern)
  3. Too much vomiting which results in loss of weight or dehydration (dry lips, decreased dark coloured urine)
  4. Pain in lower abdomen , which comes in waves,  at increasingly shorter intervals and is growing in intensity , associated with blood or sudden gush of fluid through vagina (premature labor is a big concern)
  5. New onset headache, vision disturbances, swelling of feet, constant upper abdomen pain (preclampsia is a big concern)
  6. Too big or too small baby bump or too little or too much weight gain (check out : normal weight gain in pregnancy)
  7. Decrease in baby’s movements substantially (as given above)
  8. Fever with rashes, burning in passing urine, presence of patients of TB at home
  9. Feeling depressed or disconnected with the pregnancy or baby, having resentment towards the situation or thoughts of harming yourself or baby- depression is common during pregnancy or for some time after the birth of baby. You need to discuss this with your doctor, so that help can be offered
  10. Sudden pain in leg (DVT – deep vein thrombosis is a concern)
  11. Foul smelling discharge from vagina (STD is a concern)

Also find information on what are the normal changes in your body and how baby grows in the womb and on common problems during pregnancy

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