Pregnancy: Normal Course and Expectations

Pregnancy is a time in a woman when she is carrying a developing baby in her uterus. This is a natural process which is possible in all women of reproductive age if she chooses to pursue it. In humans, the normal period of pregnancy is 40 weeks from her last menstrual period which is roughly 9 months in duration. This time is separated into 3 trimesters with distinct features to care for in each.

The Trimesters of Pregnancy

First Trimester: This is generally taken to be the time from the last menstrual period up to the 13^th week of pregnancy. This period is critical as this is the time for organ development and many external factors can affect the growth of the fetus. Medicines and several illnesses can affect the baby and it is therefore important to be vigilant. This is also the time during which there is the highest risk of miscarriage.

Second Trimester: This period lasts from the 14^th to the 28^th week. During this period, the baby develops further with discernible heart sounds. The movement of the baby can be felt by the mother. Several tests are generally recommended during this period including an ultrasound and blood tests for the mother to monitor well being of the growing baby

Third Trimester: This lasts from the 29^th week till the birth of the baby. During this time frequent visits to the Obstetrician is recommended to follow up on the mother and growing baby. The position of the baby in the mother’s uterus is checked to evaluate for the preparation of childbirth. It is advised at this time to restrict travel to a minimum. Avoiding travel by air is recommended.

Preparation for Pregnancy

Pregnancy may be planned or unplanned depending on the situation, but the following can be kept in mind while planning a pregnancy

• Intake of folic acid supplements during the conception: Folate is a vitamin which has been shown to decrease the incidence of neural tube defects in the baby. Neural tube defects are abnormalities in the development in the spinal cord and brain which range from minor defects in the vertebral column covering the spinal cord to complete absence of the brain.
• Smoking cessation: Smoking cigarettes is associated with fetal defects and is advised to be stopped.
• Stopping alcohol consumption: Alcohol can cause fetal alcohol syndrome which is marked by mental retardation and facial abnormalities and is best avoided completely.

Signs and Symptoms of Normal Pregnancy

• Amenorrhea or absence of menstrual bleeding
• Mild abdominal discomfort and bloating is possible
• Nausea and vomiting: This is what is commonly encountered as morning sickness. This is common during the first 3 months, usually subsiding with progression of pregnancy.
• Enlargement and heaviness in the breasts
• Increased frequency of urination
• There is weight gain of about 20-25 lbs  during the course of pregnancy
• Quickening: This is the pleasant feeling in the abdomen experienced when the fetus moves within the uterus. This is generally felt for the first time in the 4^th to 5^th months of pregnancy

Diagnosis of Pregnancy

Pregnancy is considered in all women of reproductive age who present with absence in menstruation. The following tests are used to confirm the pregnancy

• Urine pregnancy test: This is a simple test where the woman is asked to pee over a card. The card tests for the presence of β-HCG, which is a hormone produced by the ovary after ovulation and successful fertilization. This can detest pregnancy as early as 3- 4 weeks after the last menstrual period
• Abdominal Ultrasound: An ultrasound is always done in women to confirm the pregnancy and to verify its location within the uterus.
• Transvaginal ultrasound: This test involves inserting the ultrasound probe through the vagina and is more accurate at detecting pregnancy at an earlier stage

Evaluation of Fetal Well-Being

Once diagnosis is confirmed, additional tests are done to evaluate the mother’s health with the recommendation for regular follow up. Some more tests are required at specific periods during the course of the pregnancy to monitor fetal growth and well being

Initial tests

• Complete blood count, including haemoglobin and platelet levels
• Blood group
• Viral markers for Hepatitis B, C and HIV and antibody titres for Hepatitis B and Rubella
• Urine routine and microscopic exam with culture
• Thyroid hormone profile
• Fasting blood sugar

Special tests

• Glucose tolerance testing: This is a test done around the 6^th month to look for diabetes or elevated sugars associated with pregnancy
• Screening of Down’s Syndrome: A series of blood tests are conducted to look for special markers to suggest down’s syndrome. An ultrasound is also done in the 3^rd month to look for signs. If suspicion is present, additional invasive tests are done to examine the fetal cells and chromosome pattern
• Vaginal swab in the final trimester to look for any infective colonisation of the vagina with a bacteria, streptococcus aglactiae which can cause meningitis in the infant if untreated.

Follow up testing

• Routine clinical exam of the mother’s vitals are made including blood pressure.
• The mother’s abdomen is examined to assess for growth of the baby appropriate for pregnancy stage
• The fetal heart rate is examined.
• An ultrasound is done in the 2^nd and 3^rd trimesters. The one in the 2^nd trimester is done to look for any fetal anomalies and the one during the 3^rd trimester is done to assess the position of the fetus

Precautions During Pregnancy

• Continue to abstain from drinking and smoking any substances or drugs.
• Stay away from cats and dogs, especially their litter boxes as there is a risk f contraction of toxoplasma which is an infection with potential to affect the developing fetus.
• Keep away from any individuals with suspected fever and rash as they may have any one of Measles, Rubella or chicken pox which can all affect the fetus.
• A balanced diet and mild exercise are recommended during normal pregnancy

Labour and Anticipation of Delivery

The onset of labour is marked by increasing abdominal pain with regular contractions. There is an associated descent of the fetal head in to the pelvis which can be felt by the mother. The amniotic fluid surrounding the fetus may leak out (water breaking). It is recommended to take the mother who is in labor to a hospital with a trained obstetrics team skilled at conduction both normal and caesarean deliveries

References:

• Routine Tests During Pregnancy – ACOG [Internet]. [cited 2018 Jul 3]
• Reducing Risks of Birth Defects – ACOG [Internet]. [cited 2018 Jul 3]