Pregnancy - Investigations

Antenatal checkups help gravida to give birth to healthy baby.  The aim of antenatal checkups is to evaluate the health of woman and recognise any medical or surgical

condition that can have adverse effect on the outcome of pregnancy.

In the first visit obstetrician not only confirms pregnancy but also evaluates the woman by taking her personal, family history and appropriate blood and urine examinations.  General health checkup includes total physical examination and recording height and weight of the gravida.  Common investigations in the first visit are,

Blood examination:  most importantly to know the hemoglobin percent, blood grouping and Rh typing, also for any sexually transmitted diseases, and serum hepatitis. In regions where hypothyroidism is endemic thyroid hormone test is done.  Few more tests are done depending on the gravida’s medical history.

Urine examination:   for any infection.

If the gravida is having Rh negative blood group, husband’s blood grouping and Rh typing is done to take appropriate precautions if the husband is Rh positive.  If the gravida is positive for any sexually transmitted diseases, spouse also evaluated for the same and the couple treated to prevent any complications to the fetus.

First visit:  confirmation of pregnancy, height and weight, blood pressure recording, blood and urine examination, if necessary ultrasound scanning. 

In developed countries Pap smear test is done as a screening procedure for cancer cervix.

In consecutive visits and every visit

Weight, blood pressure, fetal growth (height of uterus) is noted.  Any complaints by the gravida are addressed to.  The total weight gain in pregnancy in a normal healthy woman, with a healthy pregnancy is 10-12 Kg.  Increase in weight by 1/2 Kg a week after 16 weeks of pregnancy is expected.  Underweight woman is encouraged to gain more weight and obese to restrict total pregnancy weight gain to 6-8 Kg only.  

Blood test for hemoglobin percent and urine for any sugar and proteins is done.

If family history of diabetes mellitus is present the gravida needs to undergo test for blood sugar at 20 weeks, 28 weeks and repeated at appropriate intervals if necessary.

Rh negative group woman with Rh positive husband will have to undergo blood test (Coomb’s test) at 20 weeks, 28 weeks and 36 weeks to note any changes in the blood that may adversely affect the fetus.

Woman with hypothyroidism may have to undergo repeat test for thyroid evaluation for adjusting the dose of thyroxin hormone.

Ultrasound scanning is done early in pregnancy to confirm viable pregnancy and for dating, between 12-14^th week and around 18 - 22 weeks to rule out any fetal anomalies.   Scanning may be repeated if there are any problems affecting the growth of the fetus and evaluation of fetal growth.

Any illnesses occurring during the pregnancy will need appropriate tests.

In India gravida is given all the reports of investigations.  She has to carry all these when she visits the obstetrician.  If the clinic or hospital gives a record of all the investigations with the history and examination of woman she should carry this to her consultant at every visit to record findings.  This will help in early identification of any risk arising during the course of pregnancy.

Good antenatal care will ensure healthy mother and healthy baby.

Pregnancy - Antenatal Checkups

More than a century ago, a woman consulted the doctor once to confirm pregnancy and later at the time of delivery.  Pregnancy care and antenatal checkups (checkups during the course of pregnancy) in pregnancy have started about a century ago.  In the early 20^th century the nurses of Instructive Nursing association, Boston, had started visiting women registered for delivery at Boston Lying-in Hospital.  The dramatic improvements in the health of the newborn and mother laid foundation to the regular antenatal checkups and special care during and after delivery.

Presently a pregnant woman consults doctor (obstetrician) a week or two after the missed period till three months after delivery – totally for about one year she will be under the care of obstetrician.  Checkups in pregnancy can be categorized as – antenatal checkups or antenatal care, intranatal care – at the time of delivery and postnatal checkups/care in the following three months after delivery.

The aim of regular checkups in pregnancy is to recognise high risk pregnancy and take appropriate care to minimize complications to mother and fetus.

Obstetricians date the pregnancy in weeks.  The normal duration of pregnancy is 40 weeks from the day of first day of last menstrual period.  The first 14 weeks is termed first trimester, later upto 28 weeks is called second trimester and the last 12 weeks is the  third trimester.  The regular checkups are advised once in 4 weeks until 28 weeks, after 28 weeks till 36 weeks - once in 2 weeks and after that weekly until delivery.  After delivery, the woman should have at least two postnatal checkups, once after three weeks of delivery later in the 12th week.

  In general gravida should undergo monthly checkups till 7^th month, fortnightly till ninth month and weekly until delivery.  If the gravida has any risk associated with pregnancy she will have to visit more frequently, as advised by the obstetrician. 

In India, or any other developing country for various reasons gravida may not be visiting the obstetrician regularly.  If the woman is healthy, and has no risk factor, with the advice of the obstetrician she can cut down her visits.  A minimum of four checkups during the course of pregnancy will help to safeguard the health of gravida.  These should be once to confirm pregnancy in first three months, 2^nd visit in the fifth month, third in the 7^th month and 4^th in the ninth month.  If the gravida does not deliver in 15days she should again have another checkup.  If any risk factor is noticed during these checkups the gravida will be advised consultations accordingly.

I generally advise/persuade rural woman who are averse and ignorant of health care in pregnancy to, at least, have four antenatal checkups, use iron tablets for three months, two tetanus toxoid injections, a day admission for delivery in the hospital.  Following this simple principle will help to reduce maternal and fetal mortality and morbidity to a great extent.

Pregnancy - General Care

We all know that pregnancy is a physiological condition needing special care.  Though a natural phenomenon, it is a special condition when a woman needs professional and tender loving care from the medical professional as well as family members.  A woman becoming pregnant for the first time will be more anxious and will have many doubts about what to eat and what activities she can carry on.

Diet:  The calorie requirement of average Indian woman doing moderate work is 2200kcal/day.  If the activity is less less calories are required.  Average Indian diet has more carbohydrates contributing almost 70-80% kcal.  The rest obtained from fats and proteins.  But it is best to have 50-60%kcal from carbohydrates, 25-30%kcal from proteins and the rest from fats.  All the vitamins, minerals are obtained from various food items including fruits and vegetables. 

In pregnancy as the woman nurtures another life in her body she has to take more food. The burden of pregnancy requires woman to increase calorie intake by 15-20% during the course of pregnancy and another 5%-10% in the lactational period.  This is about extra 300kcal in pregnancy and 500kcal in first 6months of feeding and 400kcal in the next 6 months of feeding. 

As pregnancy is a body building process protein requirement is increased and it will be good to increase intake of more proteinecious foods like pulses, eggs, meat, fish and milk.

Gravida need not eat double of what she eats.  If she increases to take cereals and fats marginally and doubles the protein supplementing foods and fruits and vegetables she will meet all the needs of pregnancy nutrition.   For an average Indian diet, if the gravida adds two glasses of milk (300ml), an egg, fistful (20gm) of pulses soaked and sprouted, and any fruit like banana, guava or any seasonal fruits one or two (100gm) will provide almost all the extra nutrients and calories required for healthy fetal development.

High calorie non fibre foods and drinks are avoided.  Instead of having just two meals, food intake should be every two three hours in the day.  What ever food is taken it is better divided into appropriate portions and taken as breakfast, lunch, supper and two snacks.  Snacks can be fruits and sprouts along with milk taken early in the morning, between breakfast and lunch and lunch and supper. 

Physical Activity:  A healthy gravida can carry all the physical activities she is accustomed to previously.  Routine domestic chores, and other activities like walking and swimming can be carried out as long as she is comfortable. Yoga, and aerobics can be done only under the expert guidance.  Two hours rest in the afternoons and eight hours rest at night will keep the woman healthy.

 Employment:  Woman doing sedentary jobs can continue to do.  Employment where a gravida has a possibility of getting exposed to radiation or chemical fumes or severe physical exertion like lifting heavy weights should be avoided.  These activities can adversely affect fetal development or continuation of pregnancy till term. 

Travel:  Long distance journeys, strenuous traveling, traveling in early and late pregnancy is best avoided.  This is to avoid the woman being away from the doctor if any problem arises, particularly in late pregnancy.  If the gravida has any problem of bleeding or abdominal pain or cramps anytime, journeys are avoided other than to visit the doctor.

Sexual Activity:  A healthy gravida with a normal pregnancy in a healthy relationship can have sexual activity as long as it does not hurt her.  Over indulgence is avoided.  Complete abstinence is not a must.  If there is possibility of genital infections sexual activity must be completely avoided.  Also when gravida has history of previous abortions, or premature deliver or has bleeding in the present pregnancy or cramps in the abdomen or due to certain pregnancy conditions when the obstetrician advises abstinence is must.  It is best to restrict sexual activity in early pregnancy for fear of abortion and in late pregnancy, premature delivery.

 Addictions: Everybody is aware of the adverse effects of smoking and excessive alcohol intake and drug addictions.  All these, smoking, alcohol and ‘drugs’ have harmful effects on the fetus and compromise even maternal health and increase certain complications in pregnancy.  Hence smoking, alcohol and drugs are a strict “NO’ in pregnancy.

Healthy diet, appropriate physical activity and rest will result in healthy pregnancy resulting in the birth of healthy baby.

Seemaandhra Unrest

It is disgusting for common people to see the leaders change their stand and give contradicting statements.  Because of the false assurance of the Seemaandhra leaders common people of that region are suffering.  The formation of Telangaana is a long pending demand.  If ever Seemaandhra political junta had any sense of attachment to Telangaana or Telugu unity, they would have strictly followed all the regulations brought by the Union government for the protection of rights of Telanganites.  But they were selfish to the core.  The propaganda of unity of Telugu people is exposed when they declare that Telangaana can be given sans Hyderabad. 

These crooked industrialist politicians scant regard for the welfare of people of their region.  They gave false assurance that the will never allow the formation of Telangaana under any circumstances.  They twisted and masked the history of formation of Andhra Pradesh.  Being in majority forever in the state, they had strong belief that their authority and fiefdom on Telangaana will continue for ever.  In a democracy it is the responsibility of the government to protect minority.  After prolonged agitation of Telanganites the Union government of India has finally taken decision for formation of State of Telangaana.  After announcing the resolution on Telangaana, Seemaandhra leaders started enacting new dramas.  They conveniently forgot that it was election promise of Congress in the year 2004 and 2009.  BJP has promised Telangaana in the year 1999.  Shri Lal Kishan Advani revealed that BJP could not form Telangaana state along with other three new states as Shri Nara Chandra Babu Naidu was against it.  Now we understand that Chandra Babu Naidu who scuttled Telangaana formation in the year 2000, and took ‘U’ turn in the year 2009 December is responsible for the death of more than 1000 Telangaana youth. 

Chandra Babu Naidu who considers himself a great politician is simply a cunning fellow without any principles.  His aim is to be in power.  He is sentimental and emotional in considering Telangaana issue.  Had he been pragmatic Telangaana demerger from Andhra Pradesh would have been smooth and pleasant with both sides distributing sweets to one another.  Jagan Mohan Reddy is always arrogant, ignorant and rash.  Late YSR’s benefit to the Seema people is fanning Jagan in comfortable position.  CBN, who is acting emotional, lost his balance and analytical ability and trying to ape Jagan.  Whatever activity YSR party takes up, he simply follows it with different name.  I think at this juncture he should give up his party and join YSR party. 

All the political leaders in Seemaandhra should understand that Telangaana is inevitable and explain the facts to people of Seemaandhra.  The reorganized Andhra Pradesh state will present more opportunities to all categories of people.  The construction of new capital and Union Government’s help to develop the state will provide employment to youth.  If the youth want to work in Telangaana they can work as they do in any other neighboring states like Bengaluru, Chennai , Maharashtra etc..  Most of the IT companies are MNCs.  Employment in these companies is based on merit and not on the region.  Government employment is for lucky 10% - 15%.  These lucky few will gain employment in their native states.  So youth need not worry at all.  All Indians have a right to stay with gainful employment anywhere in India and live with dignity.  This is constitutional right of Indians.  Sharing of water is done as per regulation and abiding by the regulation by both sides will benefit either regions.  Allocation of funds from central government will be directly to the state and help each state to develop optimally.  My appeal to Seemandhra common people is to know the facts, understand the situation and work for best deal from the Central Government.

Jai Telangaana

One step forward.  Just one more step.  

State of Telangaana is visible in great clarity.

Jai Telangaana! Jayaho Telagaana!!