Changes in Pregnancy

 Pregnancy is a natural process.  But it is a special condition which needs due care to have best outcome.  Various changes occur in the body during the course of pregnancy, delivery and lactational period.  All these changes in the woman help growth of the fetus and newborn. 

Some changes are obvious and external and some may present as symptoms in pregnancy.  As the fetus grows, the abdominal girth increases, becomes maximum by ninth month.

Enlargement of the abdomen is more obvious after 5^th month.  In the initial phase there is increase or fullness noted in the lower abdomen as the uterus grows and starts entering abdomen from below (pelvis).  Increasing size of the abdomen after 7^th month may result in stretch marks and their pigmentation.  The stretch marks are due to stretching of the abdominal skin beyond its elasticity.  Stretch marks may not appear in all women.  The protuberant abdomen may result in change postural change to maintain balance.  Also the changes in the pelvic joints preparatory to delivery may result backache.   

As the urinary bladder is close to the uterus, along with uterus the urinary bladder gets upward displacement.  In the last few weeks of pregnancy, in thin woman, urinary bladder when filled can be seen as a bulge in the lower part of abdomen.

The size of the breasts also increases, areola darkens, and small tubercles are seen on the areola.  Veins may become prominent and stretch of breast skin may result in stretch marks and they may be pigmented.  Sometimes there can be thin, watery secretion from the nipples after 5^th month. 

Apart from these external changes there are internal changes in the body.  The apparent increase in salivation is due to nausea resulting in failure to swallow it.  Sometimes gums may be swollen and bleeding from them can occur at the time of brushing.  The hormonal changes in pregnancy results changes in the stomach.  After a meal stomach takes more time to get emptied.  Some woman may experience acidity problem.  Slow movement of food in the stomach and intestines will cause more absorption of water and constipation is a common problem in pregnancy. 

The most important changes that occur are in the heart and blood circulation.  Heart has to supply blood to uterus to sustain the growing fetus.  It has to pump more blood per beat and number of beats increases as the pregnancy advances.  The increase in heart rate will be 15/min than non-pregnant state. The blood volume also increases and by term, it could be almost 50%.  The coagulability of the blood also increases.  These changes help in tolerating and limiting blood loss at the time of delivery.  

The changes in kidneys will help in clearing the waste products of increased metabolism in the body.  The efficiency of kidney increases. 

There are also changes in the lungs.  The increase in the size of uterus and becoming abdominal organ pushes the diaphragm upwards.  The respiratory rate increases per minute.  Woman may sometimes feel breathing laborious. 

To sustain growth of fetus and increasing metabolic process of the pregnancy there are insidious changes in the metabolism of carbohydrates, proteins and fats. 

All pregnant women gain weight.  The increase in weight is not just because of the fetus and placenta or increased size of the uterus but also increased maternal weight.

A healthy woman tolerates all these changes and will have successful outcome.

All the changes that occur in pregnancy will revert to normal by the end of three months after delivery.  

Pregnancy - Common Complaints - 2

Urinary frequency:  Early in pregnancy and in the last few weeks of pregnancy gravida may complain of increased frequency of urination.  This is because of growing uterus in early stage and head of the fetus causing pressure on the urinary bladder at later stage.  At any stage if the frequency is associated with painful urination, investigation is done to rule out or confirm urinary tract infection and if necessary appropriate antibiotic treatment is instituted.

Lower Abdomen Pain:  In early pregnancy there can be dull occasional lower abdominal pain due to stretching of ligament of the uterus.  This pain can be more on the right side.  If pain is intolerable simple local heat or plain paracetamol tablet will relieve it. 

Backache:  It is another common complaint which increases with period of pregnancy.  Proper maintenance of posture and using appropriate footwear will  help in relieving pain.  Avoiding excessive weight gain and back strengthening exercises will also be helpful.

Fever:  Many times a woman with missed periods consults family physician complaining of fever.  But in fact, it is not fever in its true sense, but increased warmth in the body due to hormonal changes in early pregnancy.  The temperature when recorded will always be below 99.5*F.  Explanation to the woman is sufficient.  If the temperature is 100*F, and patient is having any other complaints, appropriate investigations are done and treatment is given.

Breast Pain:  Pregnancy induces changes in the breast.  The size of the breast increases.  Gravida can also develop small tubercles on the areala.  It may become painful to touch.  After 5^th month some women may have watery discharge from the breast. 

Giddiness:  It can occur in early pregnancy due inadequate diet or later pregnancy when the uterus compresses large blood vessels when gravida stands for prolonged periods.  When there is feeling of giddiness, gravida should immediately lie down on her left.  This immediately clears the blackout.

Swelling of the feet:  generally occurs in the later half of pregnancy, most commonly in the the ninth month.  This is due to pressure of uterus on the blood vessels.  This will subside with rest, lying on the left side.  Swelling of the face or hands need special attention.

Pigmentation:  Many women may have darkening of the skin on the face (chloasma) , nipple and areola,  in the midline of abdomen.  This is again due to hormonal changes in pregnancy.  This usually occurs after 4^th month.  Exposure to sunlight may increase darkening on the face.

Stretch Marks:  This occurs in the latter third of pregnancy.  Stretch marks occurs on the abdomen due to increasing size of uterus causing stretch on the abdominal wall.  The stretch marks also can occur on the breasts.  These stretch marks can be lighter shade or may get darkened.

In general there are some complaints, which are symptoms of  pregnancy, usually more than 80% woman will tolerate all the physiological symptoms with assurance or minimal medication.    

Pregnancy - Common Complaints - 1

Young married woman who misses her regular menstrual period will suspect pregnancy.  Since the day of missed periods she will be having many doubts.  In a joint family mother-in-law or other elders will guide her or reassure her for certain routine problems.

The common complaints in pregnancy are

Nausea and vomiting:  (Morning Sickness)  More than 50% of women may have this complaint in various degrees.  Some may have occasional nausea or vomiting while others have persistent nausea which may continue rarely till delivery.  Most of the time, it will subside by the completion of third month.  Even vomiting in pregnancy, though troublesome in first three months, may continue in a lesser degree, rarely, to term.    

Indians have a habit to tickle the throat at the time of brushing teeth in the morning and bringing out all the contents of stomach.  Usually the stomach is empty in normal condition.  In pregnancy due to physiological changes the stomach emptying is delayed and there may be some digestive fluids in the stomach.  At the time of brushing and cleansing process when throat is tickled, this fluid, white or light yellowish or greenish sour fluid, is vomited out.  This is of no consequence.  The woman should stop this forcible vomiting.

Minor degrees of nausea and vomiting may respond with counseling, reassurance, change in diet with easily digestible nonspicy foods.  Sometimes gravida (pregnant woman) may

have intolerance to certain odours and sight of certain foods.  The sight and odour of the food itself induces nausea and vomiting.  In such conditions it is best to avoid such foods.  When nausea and vomiting are interfering with nutrition of the patient, simple medication like doxylamine succinate with pyridoxine tablet is advised.  If persistent, more powerful pregnancy safe anti-emetic like phenergan tablets will be administered.  Rarely a gravida may have persistent vomiting and will be unable to retain anything taken orally resulting in deterioration of health.  In such conditions she is hospitalized and parenteral treatment is initiated.  Gravida should be investigated for her health status and to rule out any obstetric or medical condition resulting in intolerable vomiting – Hyperemesis gravidarum.  Correction of electrolyte balance and IV fluid administration and anti-emetic inject:ions will generally restore the health of the woman.  Usually nausea and vomiting will subside and general appetite is restored by 12^th to 14^th week of pregnancy.

 Excessive Salivation: Sometimes woman may have excessive salivation - always wanting to spit. This will subside by the end of third month.  Rarely medication is required.   

Heart Burn: Some women may also have heartburn – burning pain in the middle of the chest.  For relief of this gravida is advised not to lie down immediately after taking food.  Avoiding spicy foods and eating curds or drinking buttermilk can reduce the symptom to a great extent.  After having food it is better to be in reclined position for some time than to lie down.  In occasional cases antacid liquid may be used.

As the pregnancy progresses some women may feel fullness with small quantity of food.  In such condition she should have frequent meals in small quantities. 

Constipation: Another significant problem in pregnancy is constipation.  This may become the cause of manifestation of piles – bleeding with defecation.  Constipation can be corrected by taking foods having more fibre – vegetables and fruits and drinking plenty of water. 

                                                                                                    ......contd

Thousand Murders

I am very much anguished at the present situation in Andhra Pradesh.  The politicians seem to have no principles.  Their only principle in life appears to be in power.  They do not seem to have any ideals or morals.  Power hungry monsters do not have any qualms in killing people with their irresponsible activity and statements.  They take pride in creating public turmoil for achieving political mileage. 

Nara Chandrababu Naidu thinks himself to be great political strategist.  The back stabber who took reigns of TDP, by backstabbing his father-in-law, is a power maniac.  He never likes to utter the word ‘Telangaana’.  But to gain power in the state he had given letter to the central government to take decision on Telangaana.  He even blamed the congress and central government of India for not taking decision on Telangaana.  When decision of Telangaana is announced by the Home Minister of India on December 9^th, 2009, he was the master mind behind the Seemaandhra MLAs and MPs resignation drama.  This led to agitations in Telangaana and almost 1000 youth have committed suicide till date.  

Finally, the ruling party has declared its decision to forward the process of formation of Telangaana state.

Now Nara Babu is instigating Seemaandhra people to agitate against Telangaana formation.  Telangaana people have achieved their state after a democratic struggle for 60years.  The instigated agitations by Seemaandhra people against Telangaana formation only exposes their dictatorial attitude against which all these years Telanganites struggled.  In support of Seemandhra people Chandrababu Naidu started “telugu jaati aatma gourava yatra”.  Under this pretext he is igniting anti national feeling in the people by questioning the Center’s authority on the state.  It is obvious by his speeches that he is considering Andhra Pradesh as a different nation and not a state in the Indian Union.  He unabashedly discloses that he negated Telangaana formation when the BJP in NDA government in the 2002 wanted to grant statehood to Telangaana along with the formation of other states – Chattisgarh, Jharakand and Uttaranchal. 

Chandrababu Naidu, who stood with Seemaandhra people, always scuttled the formation of Telangaana.  Had he been a true leader working for the betterment of people of all regions he would have consented for formation of Telangaana in 2002 itself.  His foul play has resulted in the death of 1000 Telangaana youth.  All the suicides of Telangaana youth are nothing but mass homicide by Seemaandhra biased backstabber power greedy political monster.  

It is said that a person who lives by the sword dies by it.  We should just wait and see how this man sees his end.

Early Pregnancy

Procreation is one of the fundamental desires of a living being.  Every person would like to have children of his/her own.  In a happy marriage pregnancy is a celebration.  This is a step towards firm establishment of a family.

 

In a healthy couple the chance of conception is 60-70% within 6 months, about 80% conceive within one year and another 10% within 2 years.  Couple not using any contraception and do not conceive within 2 years need evaluation.

The first indication of pregnancy is failure to have menses in a regularly menstruating woman.  Within a week of missing period, pregnancy can be confirmed by any home pregnancy test.  As days pass by woman may have impaired appetite, nausea, sometimes occasional vomiting.  This is the time when woman consults obstetrician. 

In the early pregnancy a visit to the obstetrician helps in basic health evaluation of the woman.  In a healthy woman in the first 3 months of pregnancy the only medication that is advised is folic acid tablets.  This will reduce the incidence of certain abnormalities in the fetus, central nervous system in particular.  If the nausea and vomiting are not bothersome no medication is necessary.  Nausea and vomiting are generally more in the mornings, hence morning sickness.  This can be overcome by reassurance, taking small frequent feeds, avoiding spicy foods and long hours of starvation and also starting the day with eating than drinking coffee or tea or milk. Milk is preferred as it is healthier than tea or coffee.  If the nausea and vomiting are persistent resulting in starvation and dehydration in woman, medication is advised.  This is usually a combination of pyridoxine – a vitamin and doxylamine tablet.  It is taken twice or once daily depending on the preparation.

The first three months of pregnancy (first trimester) is critical for the development of the fetus. This is the time when all the organs are formed.  This is the time when certain medicines, infections and radiation can cause a disturbance in the organogenesis that can lead to minor or major malformations in fetus.  Any medication during this time is taken under proper guidance only. 

A healthy woman needs one checkup in the first three months of pregnancy.  A healthy woman can carry out her regular activities.  Women who are doing manual labour or strenuous work or getting exposed to chemicals or radiation should avoid it.  Pregnant woman can carry on her physical activity as long as she is comfortable. 

Pregnancy in general a physiological condition and initiates certain changes in the body that continue during the course of pregnancy.  With the support of the family and under the guidance of obstetrician woman will adjust to all changes and will have a successful and happy outcome. 

NaMo

Like many in the state I was eager to hear what Mr. Narendra Modi would speak at LB stadium.  His speech was not inspiring.  He just quoted the facts that everybody knew.  He did not present his vision of India/Bharat and what plans he has to make it realise.  Youth is worried about the situation in India and NaMO is worried about youth.  But what will he do for betterment of the youth?  What are his plans for upliftment of the women and downtrodden classes?  I think he should bring forth the plans he have for making India a developed country. 

Mr. Modi, before coming to the venue met the rich and powerful private persons in the state.  I think that is an indication for his priorities.  His praise for NTR will not be appreciated by Telangaana people at this juncture. “Yes we can, yes we will”, doesn’t sound original or ‘desi’.  His addressing of the present turmoil in state is inadequate.  I felt, “he came, he failed to conquer, and he went”. 

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AP CM Kiran Kumar Reddy says that Modi had acted as he met actors immediately before arrival to the venue.  I think all politicians are actors.  Everyday we see politicians giving contradictory statements, or denying what they said and sometimes even blaming the media or journalists, saying that they were wrongly interpreted.  In the present situation of formation of Telangaana state everyday every politician of Seemandhra expresses contradictory statements every hour with great seriousness. 

For the past three years every MLA and MP with origins in Seemaandhra said they would abide by the ‘High Command” decision or Union government’s dictat.  But the moment decision on Telangaana is announced all these people simply say that it is done in haste and without any consideration.  Watching the expressions and body language lets us know how biased every Seemandhra Politician is. 

The BJP says if it comes to power it will form Telangaana state within 100 days.  But in the parliament Venkaiah Naidu says congress has not addressed the Seemandhra people’s sentiments and taken a hasty decision and that is the cause of all the reverse agitation in Seemandhra.  His impatient long face as the discussion on Telangaana was going in Rajya Sabha will not be forgotten by Telanganites.  Also when Modi came to Hyderabad he talks about Jai Andhra agitation and gathering then, conveniently forgetting the huge gathering at Nizam’s college when Mrs. Sushma Swaraj addressed Telangaana youth in December 2009.  He and Telugu Desam Naidu are behind the BJP’s failure to form Telangaana when three other new states formed in the nation during BJP rule.  Even now given a chance, these two Seema Naidus will hinder the formation of Telangaana state. 

Chandra Babu Naidu, leader of a regional party and Venkaiah Naidu, a leader in national party, fail to consider Telangaana issue in a democratic way.  Belonging to Seemandhra they are thinking locally, to be precise, as personal issue and becoming emotional.  They are giving importance to their native place and people but are not considering the constitutional rights of Telangaana.  If the politicians rise above personal feelings, and think in larger interests of people of all regions and religions, people will have faith in democracy.  Otherwise there will always be agitations.

When it comes to acting, I think KKR should be given best actor award for the role he is playing in the state now.  Though he speaks weird Telugu in media interviews, he actually can speak good Telugu when emotional. 

Whatever is going on in Andhra Pradesh is worrying people of all regions.  Only politicians are having good time hosting breakfast, lunch and dinner to their colleagues and having get-togethers.  I pray that these dramas should end and peace prevail in all the regions of the state.

Telangaana - Democratic Achievement

I do not understand why every party is blaming the other party as cause for Telangaana State formation.  It is not the formation of a new state but demerger of the Hyderabad state from Andhra Pradesh formed on experimental basis in 1956.  The merger itself was conditional.  Andhra people who were in majority and promised for unity and development of Telugu people failed to keep their promises.  They started to discriminate the local people – people of Hyderabad state – Telangaana people.  They ridiculed the language and culture of Telanganites forgetting that they have joined them as all being Telugu speaking.  This led to unrest in Telanganites within 2-3 years of merger resulting in serious agitation in 1969, when the central government suppressed it with military action causing the death of about three hundred Telangaana youth. 

Though suppressed, the Telanganites never gave up the aspiration for the Telangaana state - separation from the Andhra Pradesh. This aspiration of Telangaana people is taken as the main agenda and Telangaana Rashtra Samithi, a political party, is formed under the leadership of Shri K.Chandrashekar Rao in 2001.   KCR’s political shrewdness and his policy to achieve Telangaana not just by agitations but through the power of ‘vote’ in a democratic way have made him the one and the only leader of Telangaana people. With the support of people – educated and employees and students he could take the struggle forward and could make the national political party Congress to commit to Telangaana in principle in 2004 general and assembly elections. This is his important achievement as TRS party leader.  

His fast unto death, unending agitations in Telangaana and call for a ‘peace rally’ on 10^th December by all student Joint Action committee of Telangaana led to the pronouncement of  ‘initiation of Telangaana state formation’ by Home minister of  India on 9^th December, 2009.  This announcement was the result of KCR’s fast unto death resulting state wide protests against the Andhra Government by students and general public and political and intellectual leaders.  The announcement had come after all party meet in the state and serious discussions in the both houses of parliament. Telangaana State formation is not the gift by any party or person.  It is the democratic achievement of Telangaana people by their nonviolent consistent struggle daring the cruel oppression and violence by the Andhra government and police.

The sociocultural humiliation, political domination resulting in backwardness and oppression of Telanganites by the majority Andhra people are the sole cause of Telangaana struggle for demerger of their state from that of Andhra Pradesh.  The cause for Telangaana movement is the malicious attitude of Andhra junta and Industrialists.  Telangaana people achieved the state by their prolonged consistent struggle.  Telangaana is not given by any party.  It is the democratic achievement of all Telangaanites.

Jai Telangaana!  Jayaho Telangaana!!