The other common symptoms are nausea, vomiting, shortness of breath, fatigue, and tiredness.
On examination the doctor may notice a enlarged uterus which can be felt through the abdomen only when more than 12 weeks of pregnancy.

Diagnosis of pregnancy

The pregnancy hormone is ß- HCG. This is easily detected by a simple two minute home pregnancy test. An ultrasound examination can confirm the pregnancy. It will also give very valuable information on the number of fetuses, location of pregnancy, size of the sac and overall health and viability of the pregnancy.

Common problems in pregnancy

Nausea, vomiting and heartburn are common problems. One should avoid fried and spicy foods and maintain good hydration. It is safe to take doxylamine, and vitamin B -6 which are effective in preventing and controlling the symptoms. Ondansetron has also been used effectively. One may also have loss of appetite and very peculiarly have complete aversion to sight of some foods.

Constipation is also a common problem. It can lead to piles and unnecessary blood loss during pregnancy. Increasing fluid and fibre intake, and stool softeners can help tide over the situation.

The three trimesters of pregnancy

The first trimester

This is from the time of conception to 12 weeks
The commonest symptoms during this time are nausea, vomiting, and heartburn. These can be easily treated.
The commonest problem during this time is a miscarriage i.e. pregnancy loss. This will present as abnormal vaginal bleeding per vaginum and may be associated with pain. It is diagnosed on ultrasound examination.

The second trimester

This lasts from 12 weeks to 28 weeks
By this time the nausea and vomiting subside. The risk of miscarriage is reduced. Formation of the major organs is completed by 20 weeks. After that the fetus is increasing in size.

The third trimester

This lasts from the 28 weeks to 40 weeks. It is at this time that many important medical issues may surface. Anemia may worsen. One may develop pregnancy induced high blood pressure and gestational diabetes which have implications on the health of both the mother and the fetus.

It is during this time that one may go into preterm labor. There is risk of bleeding during this time mainly due to two causes i.e. abruption and placenta previa.

Labour

This may start any time after 37 weeks. In fact most women will deliver before the due date. Only a small percentage actually delivers on the due date and a few will go beyond the date.

The common symptoms of labor are

- Onset of labor pains i.e. contractions that gradually increase in amplitude and frequency.
- Passage of thick blood stained mucoid discharge.
- Breaking of the forewaters i.e. leaking of the liquor.

The common signs of labor are

- Confirmation of the above
- Dilatation of the neck of the womb i.e. cervix
- Descent of the presenting part of the fetus

First stage

This starts from the onset of labor to the time of full dilatation. The woman is admitted to the delivery suite. Monitoring of the labor process is done continuously to ensure that there is good progress. Cardiotocographic monitoring is routinely done to ensure wellbeing of the fetus.

Painless labor

In modern obstetrics there is no place for a painful labor. The timely use of epidural analgesia has made labor a memorable experience.

Second stage

This starts from full dilatation to the delivery of the fetus.

This stage is also very crucial as prolonged second stage can lead to instrumental and /or traumatic delivery for the mother, fistulas and asphyxia in the fetus.

Third stage

This stage starts at the delivery of the fetus and ends with the delivery of the placenta.

This is an important phase wherein sudden large amount of blood loss can occur due to various reasons. Active management of this phase is required as the blood loss can be prevented.

Post delivery

The patients are discharged within 24 – 48 hours after vaginal delivery and in three days after a cesarean section. Lactation is encouraged as soon as the baby is delivered.

Good care of the breast and the episiotomy is advised. Patients are advised to follow up for discussion and implementation of contraception.

Routine checks in pregnancy

The first antenatal visit is recommended as soon as the pregnancy is suspected or diagnosed. The subsequent visits can be done as follows.

· Once a month up to 28 weeks.
· Twice a month up to 34 weeks
· Then once a week up to delivery

This is only an approximate schedule for a low risk uncomplicated pregnancy. The schedule can change according to the circumstances at that time.

The commonly advised tests are CBC, blood group, Thyroid estimation, HIV, VDRL, HBsAg, sugar level estimation and routine urine analysis. Various special tests may be required depending on various medical situations eg. Antiphospholipid antibody in cases of recurrent miscarriage.

Triple marker is offered to all at 16 weeks. Obstetric ultrasound examination is done at various stages- in first trimester for dating, location of pregnancy and to look for multiple pregnancies, in second trimester for the study of anatomic defects, and in the third trimester for growth. Additional ultrasound and Doppler examination will be required in special circumstances for eg Preterm labor and abnormal bleeding in pregnancy.

CBC and sugar tolerance is repeated at 28 weeks.

Common supplements in pregnancy.

Iron and calcium supplements are commonly given to pregnant women. Folic acid supplement is given even preconception and continued into the first trimester. There is enough scientific evidence to support its use to prevent neural tube defects. Tetanus toxoid is given, usually two doses one month apart starting at 28 weeks. The role of Essential fatty acids, Vitamin E, Lecithin and Arginine are not yet convincing and therefore not recommended as a routine.

Dr Sangeeta Agrawal has a passion for obstetrics i.e. care of women in pregnancy. You can feel free to ask queries via email regarding this important event in your life. She provides quality compassionate care during pregnancy.