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Pregnancy

Pregnancy

If a woman suspects that she is pregnant or has a positive home pregnancy test, she should make an appointment with a health care provider, which could be a doctor, an obstetrician (women's health specialist), a midwife, or a nurse practitioner. Early care (prenatal care) is essential for a healthy pregnancy.

A woman who is pregnant should call her health care provider if any of the following conditions develop:

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Seek care in a hospital's emergency department if pregnant and experiencing any of these conditions:

  • Fainting
  • Vaginal bleeding through more than one pad per hour
  • Having severe pain in the abdomen or shoulder or the sensation of being about to pass out
  • Passing pink, gray, or white material from the vagina that does not look like a blood clot (The woman who is pregnant should take the material to the hospital.)
  • Having a bloody discharge or gush of water from the vagina late in pregnancy (The woman who is pregnant may be going into labor.)
  • Having a seizure but without a history of  epilepsy   (This may indicate eclampsia, a complication of pregnancy.)
  • Having an injury, such as a fall, a blow to the stomach or pelvis, or a car accident

Lower abdominal pain late in pregnancy may be labor pains, which are contractions of the uterus. The woman may try to drink a quart of water, lie on her side, and see if the symptoms resolve over two hours. If the symptoms do not resolve, she should see a doctor.

Questions to Ask the Doctor

  • Am I at risk for genetic diseases?
  • How much weight should I gain?
  • Am I gaining weight too fast?
  • How should I alter my diet (especially if a vegetarian or a vegan)?
  • What tests should I have and when should I schedule them?
  • Am I a high-risk patient?
  • What is my risk for cesarean birth?
  • What exercises are safe?
  • What vaccinations should I have?
  • What medications may I take?
  • May we develop a birth plan?
  • Should I hire a doula?
  • Will I be allowed to keep ultrasound pictures?

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Self-Care at Home
  • Eat small, frequent meals throughout the pregnancy. Eat a common-sense balanced diet  . Expect to gain between 25-35 pounds if you are of normal weight. Expect to be on weight restrictions if you are obese, and in this case you should only gain 10-15 pounds.
  • Do not discontinue prescribed medications without consulting a doctor, but also consult with a doctor before taking any nonprescription medications.
  • Ginger capsules (available as an over-the-counter option) may help with nausea in pregnancy, sometimes called morning sickness. Talk with a doctor about other options.
  • Do not smoke, drink alcohol, or use street drugs.
  • Continue to exercise with normal routines unless the doctor advises otherwise; be sure to get adequate water intake for exercise.
  • Sexual intercourse is safe and natural during an uncomplicated pregnancy.
Follow-up

For the first few months of pregnancy, monthly doctor's visits are standard. After that, visits are biweekly until the last month of pregnancy when doctor's visits are weekly. Usually, blood testing and anemia   checks are performed at the first doctor's visit and at the 16- and 28-week visits.

The doctor will probably provide the woman who is pregnant some information to read about pregnancy. She should ask questions if she needs help understanding the information or what is happening during the pregnancy.

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Prevention

Contraception is the term used for preventing pregnancy. There are many ways to prevent pregnancy, but none of them is 100% effective except not having sexual relations (abstinence). The following currently used methods of contraception can vary widely in their effectiveness:

  • Sterilization - Male (vasectomy) or female (tubal ligation, tubal implant, Essure sterilization)
  • Hormonal contraceptives - Birth control pills , birth control patches, birth control vaginal ring
  • Intra-uterine device (IUD) or intra-uterine system (Marina)
  • Imp anon (implant)
  • Diaphragm
  • Cervical caps
  • Condoms
  • Spermicidal
  • Coitus interrupts - Withdrawal by the male before climax
  • Rhythm method - Not having sex during the time when is woman is most likely to be fertile
  • Emergency contraception
Outlook

Many events determine the outcome of a pregnancy.

Maternal weight gain:

The amount of weight a woman gains when pregnant can be important in predicting a normal pregnancy.

  • Too much weight gain puts the woman who is pregnant at risk for diabetes   and hypertension  , and it may increase the chance for needing a cesarean birth.
  • Too little weight gain puts the baby at risk for growth restriction and the mother at risk for anemia, nutritional deficiencies, and osteoporosis  .

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Nausea and vomiting:

Even if the woman who is pregnant experiences what seems like an abnormal amount of nausea and vomiting (morning sickness), it probably will not affect the baby's health, particularly if the woman is still gaining weight at the expected rate.

Maternal diabetes (types 1 and 2):

If the woman who is pregnant has diabetes or develops diabetes during pregnancy, it can cause early labor, birth defects, and very large babies.

Low or high red blood cell counts:

The normal red blood cell count range varies slightly between laboratories, but is generally 4.2 – 5.9 million red cells per micro liter. The risk of having a baby prematurely is increased if the woman's blood count is low (anemia). Low blood counts also put her at risk of needing a transfusion after delivery. If the woman's blood count is too high (polycythemia), her baby may be smaller than expected.

Maternal obesity:

A person with a body mass index (BMI) over 30 is considered obese. If a woman who is pregnant is obesity and has diabetes, her baby is three times more likely to have a birth defect. If she is obese but does not have diabetes, the risk of birth defects is not increased.

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Maternal age:

If the woman who is pregnant is older than 35 years, her baby has a higher risk of birth defects and complications. The focus of genetic screening is to enable the woman to understand any problems her fetus or infant may have. There is a 2-3% rate of major birth defects in this population.

Folic Acid Deficiency:

A pregnancy which is deficient in the nutrient folic acid, also known as foliate, could lead to neural tube defects in a fetus. Neural Tube Defects are malformations of the brain and spinal cord which typically occur with in the first few weeks of pregnancy; therefore, folic acid supplements should be taken prior to conception and during the course of pregnancy. It is recommended all non-pregnant women take a daily supplement with 400mg of folate and pregnant women take a supplement with 600mg of foliate.

DHA Deficiency:

During pregnancy, a diet which is deficient in the omega-3 fatty acid docosahexaenoic acid (DHA) could lead to inadequate development of the eyes, brain, and central nervous system of a fetus. It is recommended that pregnant and lactating women consume 300mg DHA per day, which can be found in animal meats, fish, eggs, and vegetable oils.

Omega-3 Fatty Acid Deficiency:

Having an Omega-3 deficiency during pregnancy can be harmful to the mother and baby. Omega-3's are polyunsaturated fats that support the growth and development of a fetus and help reduce the risks of pregnancy complications. It is recommended women consume 300mg of Omega-3's daily during the course of pregnancy, which can be found in cold water fish, eggs, walnuts, and dark green leafy vegetables.

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