Pregnancy is usual a time of great joy and excitement for a couple and their extended families. Most women may discover their pregnancy because they suffer from common signs of early pregnancy, missed periods, nausea, vomiting, breast tenderness and fatigue. However some women may have symptoms, such as abdominal pain, bleeding or excessive vomiting, which may be a cause for concern and warrant urgent medical attention.
Vaginal Bleeding Bleeding in early pregnancy can vary from spotting to a heavy blood loss or passage of fleshy material. In most cases the bleeding is light and doesn’t result in any harm to you or your baby. In 10% of cases unfortunately, this may result in a miscarriage. Vaginal bleeding and pain may be due to an ectopic pregnancy or a miscarriage and ultrasound scan should be performed. The ultrasound scan is used to determine where the baby has implanted and whether it is alive. Additional blood test and scans may be required if the initial scan is inconclusive or if your doctor believes that the pregnancy is still in its early stages.
Pelvic or Abdominal Pain As the baby grows in the womb some women may experience pelvic or abdominal discomfort. This may occur because the womb is reverted and is initially trapped in the pelvis. As the uterus expands, the uterine ligaments stretch and this results in a pulling pain on both side of the abdomen made worse by fetal movements. As mentioned above, worsening pain in the earlier part of the pregnancy may indicate miscarriage or an ectopic pregnancy. Alternatively, pain may also be associated with degenerating fibroids or an ovarian cyst. Should you have persistent or worsening symptoms, it is best that you see your gynaecologist.
What Is An Ectopic Pregnancy?
An ectopic pregnancy, is a pregnancy that develops outside the uterine cavity. Most of ectopic pregnancies occur in one of the fallopian tubes but it may also occur in the cervix, ovaries, caesarean scar or elsewhere in the abdomen.
In most cases ectopic pregnancies are detected when you go for your early ultrasound scan or when there is severe pelvic pain in early pregnancy. Additionally, pregnancy hormone levels in the blood may be tested to aid in the diagnosis and treatment plan. Unfortunately, a large percentage of women do not have early ultrasound scans and present for emergency care when the ectopic has ruptured, a condition which is life threatening.
Ectopic pregnancies may be treated surgically, or with medication which causes the pregnancy to fail and be reabsorbed by the body, or by watchful waiting (expectant management). Your gynaecologist, in consultation with you, will decide on the best course of action, based on factors including the size of the ectopic, the level of the pregnancy hormone (beta -HCG) and the symptoms you may be experiencing.
Miscarriage
Unfortunately, not all happy beginnings have a happy ending and 10% of pregnancies may end in a miscarriage. Most women present with bleeding with or without the passage of fleshy material. At other times miscarriage occurs silently and no fetus or a demised fetus may be found on routine ultrasound scan. Therefore repeat ultrasound scan may be required to make a conclusive diagnosis of pregnancy loss.
There are various treatment options available for miscarriages. These include (1) simply observing until resolution, (2) the use of tablets to aid in evacuating a missed miscarriage. (3) Surgical options with or without general anaesthetic to removed retained tissue after a miscarriage. Please note that a cervical stitch/suture doesn’t help save your pregnancy if you are bleeding.
Nausea And Vomiting
Nausea with or without vomiting is very common in early pregnancy and mild symptoms are considered to be normal. However, when these symptoms persist and/or are severe it can significantly affect a woman’s quality of life. Hyperemesis gravidarum is the term used to describe the severe nausea and vomiting in pregnancy and it certainly warrants medical input and even hospital admission(s) to manage the condition. Fortunately, there are a variety of treatments available and it is advised to seek help early as the condition can deteriorate rapidly. For expert opinion on the managing your symptoms, please feel free to book an appointment.
Frequently Asked Questions During Pregnancy
- Except for iron, folic acid, and possibly calcium, a well-rounded diet should supply all the nutrients you need during your pregnancy. Very high levels of vitamin A have been linked with severe birth defects. Your prenatal multivitamin should contain no more than 5,000 IU of vitamin A. If you are already taking a multivitamin, let your doctor know.
- If your prenatal vitamin makes you sick, try taking it at a different time of day, or with a meal. Try over-the-counter vitamins with at least 400 micrograms of folic acid in them. If you are still unable to tolerate the vitamins because of nausea, please let me know.
Morning sickness (may also be noon or night) – Try small, frequent feedings especially high carbohydrate snacks. It is important to keep yourself hydrated. Even if you are having trouble keeping foods down, constantly sip fluids (such as Gatorade, Ginger Ale or juices). You may also try Vitamin B6 50 mg twice a day with or without one-half Unisom tablet (not capsule). You may try ginger capsules 250 mg four times a day. You may also try wearing sea bands, (anti-motion sickness wrist bands available at drug or marine supply stores). If you are unable to keep any type of foods or liquids down for over 12 hours or if you have lost greater than five pounds please book an appointment.
Cold or sinus congestion. – Saline only nasal spray, Vicks Vapor Rub, and Panadol, antihistamines, simple decongestants and Vitamin C may be used. If your symptoms continue see your primary care doctor.
Sore throat or cough. – Over-the-counter cough drops, plain Robitussin Cough DM and Panadol.
Headache or muscle ache. – Panadol, Ibuprofen. (No Ibuprofen before 13 weeks or after 28 weeks). If headaches persist or accompanied by other symptoms like vomiting, limb weakness or seizures, please seek medical advice from a specialist.
Constipation. – Increase fiber and water intake. Increase fruit and vegetable intake and try raisins or prunes. Metamucil or Benefiber may be used to soften stools. Next try small amounts of laxatives such as Senokot, Ducolax, or milk of magnesia if initial measures are ineffective.
Indigestion/heartburn. – Eat small, frequent meals. Avoid eating large meals before bedtime. Avoid spicy/fried foods. May try Mylanta, Maalox, TUMS and Rolaids. Elevate the head of the bed to reduce reflux.
Diarrhea. – Avoid spicy, fried foods. Drink plenty of clear liquids. May take Imodium AD, Metamucil, or Enterogermina according to package instructions.
Yeast infection. – Only use vaginal antifungal inserts during pregnancy. Oral tablets are not recommended during pregnancy. If you develop a foul smelling vaginal discharge or bleeding during pregnancy, you should be reviewed by a specialist.
Avoid constipation, use stool softeners and increase fluid intake. Additionally, you can use Preparation H or Scheriproct during pregnancy.
Increase milk and other dairy products. Decrease carbonated drinks. Increase Potassium by drinking Gatorade, orange juice or eating bananas. Do not stretch in bed. Calcium supplement – 500-600 mg once a day.
It is very common for pregnant women to retain fluid. Many women will find that their feet and ankles will be most swollen at the end of the day and that their hands and face will be more swollen in the morning when they get out of bed. Try elevating your feet and lying on your left side as much as possible during the day. You can also try maternity support stockings. If you have a sudden increase in the amount of fluid retention that doesn’t seem to improve significantly with bed rest and the above recommendations, please call your Obstetrician.
Elevate feet as much as possible during the day. Wear maternity support stockings if you will be on your feet for long periods of time. Varicose veins, which are superficial veins in the legs that are swollen, DO NOT increase your risks for a deep vein blood clot.
It is not unusual to have a small amount of bleeding after an internal examination. This is in no way harmful to the baby or yourself. The bleeding should get darker in color and less in amount over the 12 hours following the exam. If it is significantly increasing in amount and becoming brighter red, please contact you Obstetrician.
A small amount of spotting is o.k. and not a sign for alarm. However, do not have intercourse again until you have not bled for 24 hours. If the bleeding continues and if it is bright red, please contact your Obstetrician urgently.
If you have a persistent red flow of blood at any time after 20 weeks gestation, please call the office or the emergency service. Before 20 weeks, please seek medical attention for heavy bleeding, see section on miscarriage.
Many women do not feel fetal movement until approximately 20 weeks gestation and will not feel it on a regular, daily basis until after 26 weeks gestation. However after that time, you should feel your baby move multiple times every day. If the movement seems much less than what you are used to as being normal, we recommend that you lie on your left side and drink a sweet, cold drink. Place your hand on the uterus and count the movements that you feel over the next 2 hours. You should feel the baby move at least 10 times. If you are more than 26 weeks or unable to get the 10 movements as described above, please call the office or seek emergency care at your nearest hospital right away.
Yes, as long as they are used in moderation (no more than two to three drinks containing those products a day)..
It is desirable if someone other than you change the cat litter during pregnancy. If there is no one but yourself available to change the cat litter, it is recommended that you wear plastic gloves and wash your hands well afterward. Make sure feces are removed daily. However, you do not have to be afraid to cuddle or pet your kitten.
It is fine to exercise during pregnancy and, in fact, it is strongly encouraged. However, we recommend that you exercise your body to no more than a “moderate amount.” Do not exercise to the point that you are so breathless that you are huffing and panting, or that your muscles feel achy during or after the exercise. Do not do any high impact or jarring exercises.
After 14 weeks, I recommend that you avoid physical activities where there is chance for significant injury such as cricket, football, or karate. After 20 weeks, we recommend that you avoid physical activities that loss of balance could result in injury such as bicycle riding and climbing ladders.
The ideal time to travel long distances (greater than two hours away) is between 14 and 28 weeks. Travel at any time during pregnancy does not pose a risk to the pregnancy; however, you need to be prepared to obtain care where ever you are should a problem arise. We recommend you take this into consideration when making any travel plans.
After 37 weeks it is not uncommon to pass the mucous plug. It might still be several weeks before you go into labor. There is no need to call the doctor if that is all that has occurred. You should make contact if this is associated with pain, bleeding or breakage of the water bag.
If you have broken your water, you will have a continuous or frequent leakage of fluid. It might be a small or a large amount. If you are unsure if you have broken your water, change your underwear and if a large or small amount of fluid continues to trickle out of you, please make contact so that you can be evaluated. The fluid will have essentially no odor to it and will either be clear like water with possibly small, white flecks in it or a dark green or brown colored fluid. Seek immediate medical attention if the fluid is discolored, bloody or bloodstained.
Lying flat on your back in the third trimester (28 weeks and beyond) decreases the circulation of blood to your heart and uterus (baby) making you feel light-headed. For this reason, you should not to lie flat on your back for long periods of time. However, as long as you are not feeling light-headed, there is no harm in lying on your back for short periods of time and there is no harm if you wake up and find that you have rolled onto your back in your sleep. If your doctor has determined that your baby is not growing well, you should make every effort to rest on you side while sleeping as laying flat may increase the risk of the baby dying.
Meats should be thoroughly cooked (red meats at least medium). Due of concerns of a listeria infection during pregnancy, hot dogs and lunch meats should be heated so the center is steaming. Avoid unpasteurized cheeses such as brie, feta and blue veined cheese. While seafood is healthy for you, the mercury content in certain fish or excessive amounts of seafood can be dangerous for a fetal or child’s developing brain.
Check the following link for more information
https://americanpregnancy.org/pregnancy-health/diet-during-pregnancy/