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Answers for the Aspiring Mamma
Dr Geeta Chadha

“Am I really pregnant?”
Missing one’s periods calls for an immediate pregnancy test. An early visit to a doctor or an early ultrasound is important to confirm that the pregnancy is in the uterus. This is because at times, the gestation can be in extra uterine locations like the fallopian tubes or ovaries etc. These cases of ectopic pregnancy need urgent medical attention and if detected in time, can prevent catastrophic hemorrhage and at times succeed in avoiding surgery as well. An immediate visit to the doctor also gives an opportunity to the couple to allay all their fears and dispel all myths they could be holding in their minds.

Regular scanning studies reveal that a fairly large number of fetuses are generally discarded after conception by the mother’s system. If during development, there is an abnormality because of chromosomal problem or genetic causes, the pregnant lady’s system withdraws support from that fetus.

Such a fetus either self aborts or is picked up as a non viable (missed abortion) fetus during a routine ultrasound examination. Many doctors thus do an ultrasound test nine weeks after conception to establish this viability. If the fetus is viable at that time, then there is a 95 % chance that this pregnancy would go on to term.

The making of a baby
The pregnant lady is advised a series of blood and urine tests, both routine and patient specific. With scientific advancements in the last decade, blood tests and ultrasonic markers have been made available to detect certain chromosomal defects like Down’s Syndrome and Trisomy 18 and 13. Though these relatively expensive tests increase the financial burden on the couple, records show 90% viability of such tests.

The second trimester starts after completion of 12 weeks and the would-be mother now needs to be started on iron and calcium supplementation. Every antenatal check includes a weight check and blood pressure recording besides the general examination. The fetal growth is closely monitored and the fetal heart heard. At this stage, the fetal bones grow rapidly and the pregnant woman should be encouraged to eat well and healthy in order to cope up with the growing demands from her baby.

As the fetal growth advances, by about 18-20 weeks of gestation, the fetal organs are big enough for the sonologist to rule out a major structural anomaly. By this time all pregnant patients clearly can appreciate the fetal movements (heard about those “kicking” and “boxing” in the mother’s belly?). From the onset of third trimester, fetal growth and blood pressure is monitored even more closely. The mother needs to be alert to pick up soft indicators of pre term labour. If any abnormality is detected then timed intervention or early medical therapy can avert fetal disaster or reduce maternal morbidity.

And finally…
Ideally, the pregnant woman should be able to cruise along and deliver the baby any time after 37 weeks, but in certain instances like severe hypertension and fetal growth retardation, the doctor may be compelled to terminate the pregnancy early. The treating doctor takes the call after judicious consideration of all risks, and with the informed consent from the patient.

In a low risk setting, the pregnant mother can give a birth plan to the doctor. Many women opt for painless labour by opting for epidural analgesia. This involves a small injection given at the back by an Anaesthetist. With this, the lady is conscious and awake but her pain perception during uterine contraction is numbed out.

After delivery, the baby should be put to the mother’s breast as early as possible as this not only helps in establishing successful lactation, it also aids in uterine contractility, thereby preventing excessive blood loss. The neonatologist examines the baby immediately after birth for quick assessment and if need be, for basic resuscitation.

Sounds complicated, eh? One look at the tiny adorable frame and you will know how it was all so completely worth it!

Have a safe pregnancy!

Dr Geeta Chadha is Senior Consultant, Obstetrics and Gynaecology, Indraprastha Apollo Hospitals, New Delhi.  
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