Anemia, Bleeding, Breast problem, Constipation during Pregnancy

Anemia in pregnancy: -

World Health Organization(WHO) in 1972 decided that during pregnancy, if hemoglobin level in blood comes below 11 gm%, the case will be diagnosed as Anemia in Pregnancy.

Factors of Haemopoiesis (formation of blood) –

a) Minerals- Iron, Copper, Cobalt.

b) Vitamins- Vitamin B12, Folic Acid, Vitamin C

c) Protein

d) Erythropoietin- a hormone.

Causes-

A. Physiological

Disproportionate increase in plasma volume during pregnancy leads to apparent reduction of RBC, hemoglobin and hematocrit level.

Lower limit of physiological anemia is RBC up to 3.2 million/ Cmm, normocytic and normochromic red cells and hemoglobin up to 10 gm%. Iron deficiency contributes to the fall in blood vessels. Therefore, there is need for prophylactic iron therapy, which can improve physiological anemia.

B. Acquired

a) Nutritional anemia

Iron deficiency anemia

Commonest cause.

Nutritional Microcytic anemia

Due deficiency in Folic Acid and/or folic acid.

Dimorphic anemia

Protein deficiency anemia

Symptoms of Nutritional anemia- commonly asymptomatic. Fatigue, asthenia, exertional dyspnea sometimes occur. In severe cases, loss of appetite, diarrhea, breathlessness, palpitation on exertion, swelling of face and feet.

Signs- pallor, slight glossitis. In severe cases- marked pallor can be seen on palpebral conjunctiva, tongue, skin. Slight edema of feet or anasarca. Marked glossitis, cardiac dilatation, hemic murmur at heart. Heart failure.

Management

Oral iron. Prophylaxis 60mg. of elemental iron a day taken with meal after first three months of pregnancy. Addition of 500μg of Folic acid a day helps in prevention of folic acid deficiency as well.

Fresh green vegetables, fruits, egg, meat, liver should be taken.

Bleeding in pregnancy: -

In early pregnancy

Spotting.

The main cause for bleeding per vagina is Threatened abortion. It is the type of abortion without passage of tissue but possibility of continuation of pregnancy.

Symptoms- amenorrhea, scanty bright red bleeding or blood stained discharge, no abdominal pain, no history of expulsion of a fleshy lump PV.

Signs- pregnancy breast sign present. Gravid uterus is palpable. Cervical os is closed. Stained discharge is present.

Diagnosis- Pelvic Ultrasound, MRI

Treatment- Complete bed rest. Sterile pad is to be used. If any lump is discharged, one should promptly report to doctor.

Other conditions of bleeding PV are abortion, ectopic pregnancy, hydatidiform mole.

In late pregnancy

The main causes are Placenta previa, Abruptio placente,

In both the cases, position of placenta is much lower than the original site. In very low lying placenta, severe bleeding occurs.

Treatment- Complete bed rest.

Breast problem

Discharge from the nipple is a common sign and in pregnant woman is also less worrisome but it should be evaluated by a doctor. Pain on the breasts is a very common and nonspecific problem in both pregnant. During pregnancy, the breasts enlarge; they become heavier and the blood supply increases. This makes it harder to feel lumps and makes it very important that a woman have a good breast exam early in pregnancy.

Constipation

This is mainly due to the hormone progesterone, which reduces the movement of food through the digestive tract. The problem may further be increased later in pregnancy by the pressure of the growing uterus over the rectum. Iron supplements can make constipation worse.

Eat fiber rich foods such as cereals, whole-grain breads, and fresh fruits and vegetables every day. Add a couple of tablespoons of unprocessed wheat bran to your cereal in the morning and follow it with a glass of water.

Take plenty of water.

SEX, FERTILITY AND CONCEPTION

“Safe period” is a method of temporary contraception. It is a part of Natural Family Planning (NFP).

Safe Period is also known as “Calendar Method” first described by Ogino in the year 1930. This method is based upon the fact that ovulation usually occurs from12 to 16 days before the onset of menstruation. Ovulation means the release of an egg, which can be fertilized by a sperm, from the ovary.

“Safe period” can be used both to achieve and to avoid or postpone pregnancy.

The days on which pregnancy (conception) may occur is calculated are-

One should know her shortest and longest days of menstrual cycle. The shortest cycle minus 18 days denotes the first day of fertile period. The longest cycle minus 10 days denotes the last day of the fertile period.

Say for an example, a woman’s cycle varies from 25 to 32 days. The fertile period during when she may get pregnant if intercourse is done without obtaining other contraceptive methods is 7th day to 22nd days of her regular menstrual cycle.

However, the cases where such type of calculation is not possible, the couple are advised to avoid intercourse from 8th to 22nd day of the menstrual cycle, counting from the first day of the menstrual period.

To avoid Pregnancy (DRAWBACKS)

“Safe Period” is not entirely safe. The drawbacks of “Safe Period” are-

· A woman’s menstrual cycles are not always regular. When the cycles are irregular, it is extremely difficult to predict the safe period.

· This method is acceptable and applicable only to the educated, responsible and dedicated couple. A high degree of motivation and cooperation is needed.

· Compulsory abstinence of sexual intercourse for nearly one half of every month-may be called “programmed sex”.

· “Safe sex” method is not applicable during the post-natal period when there is no menstruation.

· There is a high failure rate- about 9 per 100 woman-years.

The failures are due to wrong calculation, inability to calculate on her own, irregular use, lack of motivation and “taking chances”.

Tow medical complications are reported to result from the use of safe period; Ectopic pregnancies and embryonic abnormalities. Ectopic pregnancies may lead to conception late in the menstrual cycle and displacement of the ovum; embryonic abnormalities may result from conception involving either an over aged sperm or over aged ovum.

If this is correct, the safe period may not be an absolutely safe period.

To achieve pregnancy

· Abstain from sex on Day 1 of the cycle until you have the more-fertile mucus.

· Have sexual intercourse every other day up through Peak Day plus 2.

· Keep taking your morning temperature. A recording of increase of temperature of 21 days provides you with a 99% probability that you are pregnant.

· To estimate you due date, determine the first day of sustained thermal shift, subtract seven days, and add nine months.

PREGNANCY WORKOUT

Would be mother must keep herself healthy and fit during pregnancy. The exercises mentioned below will make them fit both physically and mentally.

Value of exercises during Pregnancy

· Exercise reduces the tiredness you feel during pregnancy.

· Exercise strengthens muscles of the back, which are important to support the increased body weight.

· It reduces extra fat accumulation as mothers used to do less work during this time.

· Keeps posture in perfect position.

· Workout helps to reduce pregnancy induced stress and insomnia.

· Regularizes body to sustain during delivery period.

Primary Rules

· Take plenty of water during and after completion of exercise.

· Do not fold your legs completely during exercise.

· Avoid those exercises that give you jerks.

· Wear loose fitting garments during exercise.

· Put on comfortable snickers or walking shoes that gives your feet complete support.

· Do not overburden with exercise. If you don’t feel like someday, just skip it.

Workout Plan

· Ideal exercise during pregnancy is regular walking. It should be for 20-30 minutes, preferably in the morning. But if you do not have time in the morning, you can do it any preferable time.

· Pelvic floor exercise is very good during pregnancy. It helps the mother for normal delivery.

· You may consult your doctor or yoga teacher for demonstration of the exercises. Or you may consult websites.

· Whatever yoga you do, please do not forget to do freehand exercise.