1) CHECK UP :- Visit Dr. regularly i.e. once a month upto 7`1′ month, once in 15 days in 811′ month & once a week in 9th month. Perform Blood, Urine Tests like ANC Profile, Dual Marker Test (at 12 weeks), Triple marker Test (at 16 weeks) & Ultrasonography as advised.
2) DANGER SIGNS : Watch for Bleeding Per Vaginum(P.V.), Repeated Pain in Abdomen, Reduction in Fetal Movements, Swelling on feet and face, Leaking (Watery Discharge P.V.) SEE Dr. IMMEDIATELY.
3) SWELLING AND HIGH B.P. :- Such patients should watch for danger signals like headache, blurring of vision (blackouts), vomiting, giddiness, Urine output, sudden T in Swelling, 1 Fetal Movements, Palpitations (i rate of heart beats), Breathlessness, Pain in Upper Abdomen, Bleeding P.V.. Such a patient may soon get Fits and become Unconscious. Hence SEE Dr. IMMEDIATELY
4) ARE YOU A HIGH RISK MOTHER ? : See the chart on page 3 & 4. If yes, you need special investigations and treatment. So co-operate with Dr. & obey his instructions.
5) DIET : Take balanced diet including milk, pulses, green leafy vegetables (Palak-Spinach, Methi-Fenugreek), Fruits ( except Papaya). From 4th month, T quantity of Food by 20% and eat better quality food items. Drink boiled water. Avoid stale food & junk food. Avoid oily, spicy, nonveg foods (iAcidity). Avoid cold water & cold items (Common Cold). Avoid outside food (Loose Motions, Jaundice). Avoid oil, ghee, sweets, farsans, dry fruits (excess weight gain). If you have high B.P. & swelling, f salt intake & stop papad, chatneys & pickles.
6) PERSONAL HYGIENE :- Take bath daily. Keep private parts clean and dry. Trim nails. Do not get wet in rains. If you get wet, wipe your skin & hair dry & change clothing. If you have sweating, take bath, wipe & dry your skin & change clothes. Avoid wearing tightly fitting clothes.
7) REST & SLEEP :- At night, sleep for 8 hours & during day time, take rest for 2 hours. Bed Rest may be advised if there is possibility of Abortion or Premature Delivery or if your fetus is lagging behind in Growth.
8) PHYSICAL ACTIVITY :- Avoid hard work, lifting heavy weights. Avoid prolonged standing at one place. Working women should take leave from 8th month. From 4’1′ month, Learn from an expert, the pregnancy exercises, yoga, breathing & relaxation exercises & keep fit. These may later help you in making your delivery easy & comfortable.
9) SEXUAL RELATIONS :- Avoid it in first 3 months & last 6 weeks. If there is risk of Abortion or Premature Delivery, avoid it throughout pregnancy.
10) TRAVEL :- Avoid long distance travel. If necessary, prefer train over road journey. if journey is very long, prefer travelling by air (plane).
11) BAD HABITS :- Stop tobacco, misheri, gutka, smoking, alcohol immediately (these hamper Fetal Growth, cause Antenatal Bleeding P.V.) Persons in your viscinity also should not smoke (passive smoking).
12) POSTURE & BACK CARE :- Sit straight (erect). Walk erect. While getting up from bed, turn to one side, put your weight on one hand & then get up. Avoid high heels (Backache). While bending down, bend from knees & not from back (Backache).
13) MEDICATION :- Take Folic Acid Vit., Calcium, Iron tablets as advised, Take Injection of T.T. ( Tetanus Toxoid). Avoid self medications & across the counter medicines.
14) ILLNESSES DURING PREGNANCY :- Any Fever, Malaria, Urinary Tract Infection, Loose Motions, Jaundice, Dental Illness can harm pregnancy. Hence these require to be treated to avoid harm to pregnancy. Such illnesses definitely cause much more harm to pregnancy than the medicines required to treat them.
15) X-RAYS : Avoid exposure to X-Rays. If necessary, take X-Ray after wrapping lead aproan around your abdomen.
16) SONOGRAPHY : It may be required at 8 weeks (viability), 12 weeks (NT), 20 weeks (Anomaly), 28 to 32 weeks (Growth), 37 weeks (Fetal Well Being, AFI, Colour Doppler). It uses sound waves with low frequency & low energy, hence it does not harm fetus. DO NOT ASK FOR OR PERFORM SONOGRAPHY FOR SEX DETERMINATION, AS IT IS LEGALLY PROHIBITED.
17) PROTECTION FROM MOSQUITO BITES :- Protect yourself from Malaria, Dengue. Use mosquito nets, repellents etc.
18) PREVENT UTI ( URINARY TRACT INFECTION) : Drink lot of water and liquids. Do not hold urine for long. After passing stools, clean from front backwards & wash hands with soap & water.
19) REGULAR VISITS, TIMELY INVESTIGATION & TIMELY INTERVENTION :- These may help prevent complications or reduce bad consequences. So do co-operate with Dr. & get NST, Colour Doppler etc. tests done immediately when asked for.
20) ZERO RISK ? :- There may be development of risk or complication during pregnancy or delivery. Even in well developed countries, risk to pregnant women, fetus or newborn is not reduced to Zero. There is high risk to fetus/ newborn upto 35 weeks of pregnancy & below birth weight of 2.0 kg. From 34th week, pay careful attention to Fetal Movements. Find our from Dr. risks to you & to your fetus. Find out your risk from Anaesthesia & Surgery. If delivery pains or leaking start, telephone Dr. Immediately & bring patient to hospital at proper time.
21) PREVENTIVE MEASURES : Even if risk cannot be abolished completely, it can be attempted to be reduced. Note that by doing antenatal investigations & treatment, we are trying to do primary, secondary, and tertiary prevention.
- A IMPORTANT STATISTICS ( INDIA)
- Risk of Spontaneous Abortion 1 out of 6 i.e. 16.6%. 2) Risk of Fetal Death in 8th or 9th month or during delivery, 1 out of 30 i.e. 3.3%. 3) Rate of Infertility in couples 1 out of 10 i.e. 10%. 4) Risk of Congenital Anomaly (Malformation) in Newborn 1 out of 30 i.e. 3.3%. 5) Risk of serious Congenital Anomaly (Malformation) or Mental Retardation in Newborn 1 out of 50 i.e. 2%. 6) Risk of Fetus passing stools (Meconium) before delivering, 1 out of 7 i.e. 14%. 7) Rate of umbilical cord being present around neck 1 out of 4 i.e. 25%. 8) Rate of Maternal Mortality (Death of Mother during Pregn., Del. or 28 days after delivery) in India : 2 out of 1000 live births (i.e. 200 out of 100000 live births) 9) Rate of Neonatal Mortality ( Death in First 28 days of life) in India 29 out of 1000 lives births. 10) Rate of Infant mortality (Death in first year of life) in India 46 out of 1000 live births.
- HIGH RISK MOTHER.
- PERSONAL RISK FACTORS 1) Age < 18 or > 35 years 2) Height < 152 cm. 3) Grand Multi Para > 4 Deliveries before 4) Bad Habits e.g.Tobacco, Misheri, Gutka, Smoking, Alcohol. 5) Non compliant —Not following Doctor’s recommendations.
- FACTORS IN PAST OBSTETRIC HISTORY (PREVIOUS PREGNANCY)
1) Previous Caesarean Section operation
2) Recurrent Abortions, (2 or more Spontaneous Abortions <28 weeks.)
3) Previous Neonatal Death or Stillbirth.
4) Previous High B.P., Fits, Unconsciousness.
5) Premature Delivery < 8 1/2 months (before 37 weeks).
6) Previous Fetal Congenital Abnormality (Birth Defect).
- FACTORS IN PAST MEDICAL HISTORY (PREVIOUS ILLNESSES) 1. Diabetes, T.B., High B.P., Jaundice, Fits etc. 2. Family I-1/0. Inheritable Diseases.
- FACTORS DETECTED IN PREGNANCY
- Swelling, High B.P., Proteinuria
- Risk of preterm Delivery (<37 weeks)
- Postdated pregnancy (>40 weeks).
- IntraUterine Growth Retardation (IUGR)
- Heavy Weight Fetus (Macrosomia)
- Abnormal Presentation e.g. Breech Pm. (Buttocks).
- Antenatal Haemorrhage ( Bleeding P.V.): Low Lying Placenta or Abruption. 8. Narrow Pelvis, Nonengaged head. 9. Reduced Fetal Movements.
- FACTORS ARISING IN LABOUR (DELIVERY PAINS)
1) Fetal Distress FI-IR < 1 10 or > 170/ min or fetus passes stools (Meconium) in uterus. 2) Delayed Progress in Labour. 3) Newborn not crying after birth, requiring oxygen, artificial breathing. 4) Postpartum Haemorrhage (Bleeding P.V.) :Atonic, Traumatic, other Type. 5) Placenta not separating or delivering within expected time. 6) Perineal Tear or Extension of Episiotomy. 7) Injury to Fetus /Newborn. IF ANY OF ABOVE RISK FACTORS ARE FOUND, TIMELY ADVICE, INVESTIGATIONS AND INTERVENTIONS CAN HELP REDUCE POSSIBLE COMPLICATIONS.
- INSTRUCTIONS DURING LABOUR & DELIVERY
It is matter of two lives-Woman & her Fetus. Hence continuous presence of-one lady and one male, young, responsible, healthy close relative during labour, is absolutely essential. Inform Dr. on Tel. or Mobile when Delivery Pains or Leaking start and bring her to hospital for examination. Doctor may have to go out of Panvel for some days in a month for operations, or other work. Complications may arise any time during normal appearing Labour or Delivery. In such a situation, co-operate with Doctor in taking proper decisions. Normal Delivery is not possible without full co-operation of patient, i.e. patient should be prepared to bear labour pains for approximately 9 hours and for pushing (bearing down) for 1 hour with full strength.
Newborn should cry soon after birth, placenta should come out, bleeding should come under control, stitches should be taken & Newborn & Mother should come out of Labour Room; till then, responsible relatives must wait & meet Dr. & buy Medicines prescribed. Also, one relative must stay with patient throughout her hospital stay.
- PREVENTION IS BETTER THAN CURE
A, PRIMARY PREVENTION 1) HEALTH PROMOTION :- Good Personal Hygiene. Drink clean water. Obtain Health Education about Pregnancy, Delivery and Care of Newborn & prepare yourself physically and mentally for the same. 2) SPECIFIC PROTECTION :- e.g. for I) PRE-ECLAMPSIA (High B.P.) Low salt in diet, T. Aspirin 75 mg. / day. 2) INCOMPETENT CERVIX : (Previous I-I/o. Abortion between 5th and 7th month) — Tightening of Cervix (stitch around mouth of Womb). 3) TETANUS — Two injections of T.T. (Tetanus Toxoid). 4) RH INCOMPATABILITY: lnj. Anti-D to pregnant woman at 28 weeks (150 mcg.) After Delivery Inj. Anti D 300 mcg. to mother If Newborn is RH Positive. (within 48 hours of delivery). 5) PRETERM DELIVERY : Medicines like Isoxsuprine, Progesterone & Inj. Corticosteroid at 28 weeks to enhance Fetal Lung Maturity.
- SECONDARY PREVENTION :-EARLY DIAGNOSIS & TIMELY MANAGEMENT 1) PRE-ECLAMPSIA (High B.P.) control B.P. & deliver the patient. 2) POSSIBILITY OF PRETERM DELIVERY : Increased Bed rest, Medicines for preventing Labour Pains, Medicines to enhance Fetal Lung Maturity. 3) IDENTIFY AND MANAGE HIGH RISK MOTHER :- e.g. H/o. Recurrent Abortion or Antrepartum Haemorrhage.
- TERTIARY PREVENTION :-
1) DISABILITY LIMITATION e.g. If lady has had fits or has become unconscious.
2) REHABILITATION :-1) If Premature Delivery, rehabilitate the Newborn. 2) If Post Partum Haemorrhage, correction of Anaemia. 3) If Still-birth, rehabilitation of grieving mother.