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Pregnancy Care During Pregnancy

Pregnancy Care During Pregnancy - What it is

I'm Pregnant!

There are few experiences in life as powerful as finding out that you're pregnant. It's amazing to think that you have a new life growing inside you. From the moment you begin to feel changes in your body - or you know for sure that you're pregnant - you may begin to feel protective and look forward to having the baby. You would also probably begin to think about arranging for your maternity care.

What Does Antenatal Care Mean?

Antenatal care is designed to check your health and look for anything that could affect your growing baby. At each visit, you will have a chance to discuss any questions or concerns. Your urine, blood pressure and weight gain will be checked. Your doctor will also examine your abdomen to ascertain the position and size of the baby. In the later weeks of pregnancy, your baby's heartbeat will also be detected using a small hand-held machine called a Doptone. The assessment also involves the following blood tests:

  • A full blood count to exclude anaemia (low blood count which leaves you tired and less able to cope if you lose too much blood during or after the birth) and thalassaemia (a common genetic blood disorder in Singapore)
  • Blood grouping in the event a blood transfusion would be required
  • Hepatitis and syphilis screening
  • Rubella antibody screening (optional) to establish a history of exposure to this infection
  • An HIV screening as the implications on your baby may be significant should these infections be present

Should I have prenatal screening for fetal anomaly?

You will be offered the following screening tests:

  • A blood test (serum screening test) at 15 -18 weeks of pregnancy that analyses 2 different substances in the blood. An estimate of the risk of having a baby with a chromosomal abnormality can then be obtained. If the estimated risk is high, a diagnostic test e.g. amniocentesis would be recommended. Serum screening is not as accurate as the amniocentesis test.
  • A detailed ultrasound scan (anomaly scan) at 20 weeks. This looks for major physical abnormalities. There are however, limitations to the accuracy of the scan. If you are 35 years or older, your obstetrician will discuss amniocentesis with you, for the detection of Down Syndrome.

Do I need a special diet for two?

It is a common myth that you should eat for two. In fact most women do not need extra calories for the first 6 months of pregnancy and only require approximately 200 extra calories per day during the last 3 months.

However, because your blood sugar levels fluctuate more due to the extra demands on your body, it isimportant to eat regularly, including snacks between meals. Most women gain between 9 - 13 kg during pregnancy, although this can vary from woman to woman. You should never try to diet during this period as you could be depriving the baby of vital nutrients.

Healthy foods

The best thing to do throughout pregnancy is to eat a variety of healthy foods. They should contain certain key components necessary for growth and development. These include foods containing iron (e.g. green leafy vegetables, red meat, beans and pulses although additional iron supplements may also be given to you by your doctor); calcium (e.g. dairy produce, fish with edible bones like sardines and bread) and folate (e.g. green beans, oranges, spinach, kale or broccoli).

Try to eat something from the following food groups daily:

  • Fresh fruit and vegetables: 4 - 6 servings/day
  • Bread, rice, breakfast cereals, potatoes: at least 1 serving at each meal and 4 servings/day
  • Lean meat, poultry, fish, eggs, pulses and nuts: 2 - 3 servings/day
  • Dairy products: 2 - 3 servings/day

Try to avoid the following:

  • Raw eggs which contain salmonella
  • Home-made mayonnaise and ice-cream
  • Blue cheese
  • Liver or pates
  • Raw or undercooked meat and raw shellfish
  • Soft cheese and unpasteurized milk

Why is folate important?

Folate is a B vitamin crucial in the development of baby's nervous system. It has been shown to reduce the chance of having a baby with a neural tube defect (a disability affecting the nervous system). Folate is easily destroyed during cooking and large servings are necessary for adequate intake. The simplest way is to take a folate supplement (one 5 mg tablet daily) for the first 12 weeks of pregnancy. Folate is particularly important if you suffer from epilepsy, thalassaemia or have a family history of having relatives with a neural tube defect.

Why do I feel bloated?

This is because you are retaining fluid. Edema or water retention is a common complaint that is aggravated by standing for long periods. It is important to remember that limiting fluid intake is not the key to preventing edema. You should drink 2 litres of fluid daily --getting enough fluids is important to provide for the expanding blood volume that carries oxygen and nutrients to your baby. You should also reduce your intake of tea, coffee and cola as the caffeine content of these drinks will affect the vitamins in your food, particularly vitamin C

Can I continue to smoke or drink alcohol?

Smoking is associated with adverse effects on both you and your baby. It may cause an increased risk of miscarriages and ectopic pregnancies, placental bleeding as well as low birth weight babies and premature births. There is also a long-term relationship with decreased intellectual development of the babies and increased risk of Sudden Infant Death. You should therefore try to stop or cut down on your smoking as it is the commonest preventable risk factor.

In the case of alcohol, consumption of 15 units (1 unit = 1 small glass of wine) or more per week has been associated with a reduction in birth weight whilst consumption of 20 units or more per week has been associated with intellectual impairment in children and fetal anomaly. There is no conclusive evidence of adverse effects on growth or IQ levels below 15 units per week. Therefore, it is recommended that women should be careful about alcohol consumption in pregnancy and limit this to no more than one standard drink per day.

Should I breastfeed?

Breastfeeding has wonderful benefits - not only for your baby's health and development but also for nurturing the emotional bond between the two of you. Breast milk contains all the necessary nutrients as well as antibodies for protecting your baby during the first month when he is unable to produce his own.

In addition, it has been shown that breastfeeding helps to reduce the chance of becoming prone to allergies, eczema or asthma, especially if there is a strong family history of these conditions.

KKH's Lactation Clinic is managed by experienced lactation consultants who provide advice on breastfeeding or management of problems like sore or cracked nipples. For an appointment with a Lactation Consultant, please call tel: 6293 4044 (through the telephone operators).

What should I do about taking medications?

You should discuss with your GP or obstetrician before taking any medication especially during the first few months of pregnancy when the baby's organs are developing. This is because certain drugs are known to affect the development of the baby. If you are on long-term medication, the ideal time to review them is when you're planning to try for a baby. Coming off medication that keeps you well would put your baby at risk.

Can I continue to exercise?

If you are already attending an exercise class or sports session, inform your instructor of your pregnancy. If you are not exercising regularly, you may consider beginning a low impact sport, but should not exert yourself beyond your non-pregnant limits. Exercising not only energises you and has emotional benefits but also helps to combat back pain. Twenty minutes three times a week provides you with sufficient exercise.

Swimming and walking are two of the best activities. Remember to spend time warming up before starting and to allow your body to cool down later by stretching for at least 10 minutes. Foot exercises are helpful in improving circulation and swollen ankles, whilst pelvic rocking strengthens muscles and eases backaches. Pelvic floor exercises also help to reduce the risk of stress incontinence (urine leakage) after the birth. The use of saunas and spas in pregnancy should be done in moderation during pregnancy.

Is it safe to have sex?

There is no reason why pregnant women cannot have a fulfilling sex life. In fact, the pregnancy hormones may make you feel more responsive. As you get bigger, you may want to experiment with different positions to find one that is comfortable. If you have suffered from any early bleeding, premature labour or have a low-lying placenta, it is wise to consult your doctor who may suggest a period of abstinence.

Are there any workplace hazards?

Whilst most women can safely continue to work in pregnancy, certain jobs may require more caution. Work considered hazardous include:

  • Dealing with substances like pesticides, insecticides and certain chemicals
  • Contact with radiation
  • Exposure to hydrocarbon solvents like dry-cleaning fluids, lead or mercury.

Can I travel whilst pregnant?

Commercial air travel poses no special risks to an uncomplicated pregnancy. Domestic travel is usually permitted until 36 weeks gestation whereas international travel may be curtailed after the 32nd week of pregnancy.

You should always carry documents stating your expected date of delivery. In view of the increased risk of developing deep vein thrombosis (clots in the legs) in pregnancy, air travel should be kept to a minimum. It is advisable to walk every half an hour during a smooth flight and to flex and extend the ankles as well.

Fluids should also be taken liberally because of the dehydration effects of the low humidity in aircraft cabins. Certain conditions like severe anaemia (low blood count) or a low-lying placenta are relative contraindications to flying. Unexpected events may also occur e.g. vaginal bleeding or labour. It is important to seek medical assessment before air travel.

What are some of the common ailments of pregnancy?

Most of these problems are caused by hormonal changes and the extra strain your body is under. They are usually temporary, cause minor discomfort and can be treated simply.

Backache
Avoid lifting heavy weights and high-heeled shoes. Support your back with a cushion. Kneeling on all fours and rocking from side to side can relieve the pressure on the back.

Bloatedness
This is because you are retaining fluid, which is a common complaint that is aggravated by prolonged standing. It is important to remember that limiting fluid intake is not the key to preventing edema. You should drink 2 litres of fluid daily and should limit your intake of tea, coffee and cola as the caffeine content of these drinks will affect the vitamins in your food, particularly vitamin C. Some women also feel better when they eat less salt and monosodium glutamate.

Constipation
Ensure a diet of fibre and drink plenty of water.

Faintness
This arises from low blood pressure. Avoid long periods of standing, getting up quickly and overheating, especially in the bath.

Heartburn / Indigestion
This is a painful, burning sensation in the chest or regurgitation of acid in the throat. Eat small frequent meals and avoid spicy or fatty foods and very cold liquids. Alcohol, coffee and chocolate may aggravate the problem. Sit as upright as possible and prop yourself up with pillows at night.

Morning Sickness
This is especially common in the early months of pregnancy. Unlike its coined term, it can occur at any time of the day and usually disappears by 14 weeks. One of the main causes includes low blood sugar; therefore take lots of carbohydrates. Eat little and often -- a piece of dry toast, a cracker or a biscuit often helps to settle the stomach. Alternatively take foods with ginger.

Piles
These are dilated veins in your anus and can be very painful, itchy and uncomfortable, usually occurring from the third month onwards. Eat a high fibre diet and drink lots of water. Alternatively your doctor can prescribe suppositories and creams like Anusol for added help.

Sleeplessness
This could be due to anxiety, heartburn, your baby pressing on your bladder or sheer bulk. A hot milky drink and a warm shower may help you relax.

Stretchmarks / Striae
These are raised, red lines on your breasts, abdomen, thighs or bottoms and are usually permanent and are either common with age or inherited. Certain creams or cocoa butter may help.

Tender Breasts
Wearing a good support bra will help as your body prepares for feeding your baby.

Thrush
This is a yeast infection affecting as many as 75% of women and is important as it can be treated quickly - with a cream or pessary.

Urinary Problems
These are due to the extra weight and pressure of your baby pressing on your bladder and pelvic floor and can occur when you laugh, sneeze or run. Regular pelvic floor exercises during and after pregnancy will help.

Vaginal Secretions
Increased in pregnancy and normally white and clear.

Varicose Veins
These distended veins around your calves, back, legs or thighs may be reduced by avoiding prolonged periods of standing and exercising regularly.

What are the warning symptoms of adverse events in pregnancy?

Pre-eclampsia

What is pre-eclampsia?
This is the commonest antenatal complication affecting one in 10 pregnancies and one in 5 first pregnancies. In some cases, the illness may progress to severely affect both the mother and the fetus.

What are the symptoms?
The main symptoms include headaches, feeling dizzy, nausea and vomiting, blurred or double vision, generally feeling unwell and pain in the upper abdomen. Unfortunately pre-eclampsia can also develop without any obvious signs. It is therefore vital to attend the clinics regularly.

Preterm labour

Why is preterm labour signifant?
Babies born premature are at risk of several complications especially breathing problems. Women in preterm labour may benefit from a steroid injection. This will promote maturation of the baby's lungs should childbirth be inevitable. Other medications to reduce the severity of uterine contractions and to treat the cause of the pre-term labour e.g. infections may also be used.

What are the symptoms of labour?
Labour begins with regular, painful uterine contractions or tightening of the abdomen, 'bloody show' (blood-stained mucus) or 'breaking of your waters' (rupture of your membranes). This usually occurs at term, after 37 weeks of pregnancy. Preterm labour occurs when these signs are present before 37 weeks.

Vaginal bleeding

Why is it significant?

Early pregnancy
Light spotting or bleeding in early pregnancy may indicate the possibility of a miscarriage or ectopic pregnancy (pregnancy implanted outside the womb). However, the commonest reason for bleeding is due to implantation which occurs when the embryo is attached to the womb at 4 - 5 weeks of pregnancy.

Late pregnancy
Light bleeding with blood-stained mucus in the month before your baby is due could be a 'show' -- a sign that you may go into labour within the next few days or week. Bright red bleeding which may come and go could be from a low-lying placenta or from mild placental separation.

Reduced fetal movements

What should I do?
Babies are most active when you are at rest. This is because you are now more aware of their movements. Hence you will notice frequent movements in the evening or at bedtime. There should be at least 10 "kicks" over a 12-hour period. Conversely an active baby is reassuring and excessive movements are not cause for worry.

Why is it important?
You should be concerned and seek help if there is persistent decrease in fetal movements. Some stillbirths (babies who die in the womb before they can be delivered) are preceded by decreased fetal movements.

Prelabour rupture of membranes

What is it?
Normally the water-bag is ruptured (either spontaneously or by your obstetrician) when labour begins. Rupture of your water-bag before the onset of labour is associated with increased risk to your baby. Complications include infection or prolapse of the umbilical cord through the cervix.

What are the symptoms?
If you feel a sudden gush or continuous flow of clear fluid from the vagina, consult your obstetrician.

Where can I seek help should problems arise during pregnancy?

Go to your GP
Your nearest family physician should be able to advise you on minor medical problems such as flu, intestinal upset or rashes in pregnancy.

Urgent O&G Centre, Basement 1, KK Women's and Children's Hospital
This clinic is available for early pregnancy (below 22 weeks of pregnancy) as well as postnatal (after delivery) consultations.

Delivery Suite - Triage Room, Level 2, KK Women's and Children's Hospital
All pregnancies beyond 22 weeks of gestation will be assessed here including those presenting in labour. The decision for admission to the hospital will be made by our Senior Medical Officers in consultation with the specialists-in-charge.

Arrange for early appointments
This can be done by calling Central Appointments at tel: 6294 4050.

Pregnancy Care During Pregnancy - Symptoms

Pregnancy Care During Pregnancy - How to prevent?

Pregnancy Care During Pregnancy - Causes and Risk Factors

Pregnancy Care During Pregnancy - Diagnosis

Pregnancy Care During Pregnancy - Treatments

Pregnancy Care During Pregnancy - Preparing for surgery

Pregnancy Care During Pregnancy - Post-surgery care

Pregnancy Care During Pregnancy - Other Information

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