Early Pregnancy

Pregnancy: Top Ten Point Check List for Just Pregnant Women

Have missed your period recently? You are so excited that you do not know what to do next? You need

to proceed now systematically. Check this list and proceed accordingly.

Pregnancy Check List

Assess: Assess your pregnancy status by doing a urine-pregnancy test. Missing period can be due to

several reasons. This test becomes positive as early as three days of a missed period if you have

conceived. Check the two dark lines on the strip and confirm your gravid state.

Block: Block your dates as per an easy calculation…Just add nine calendar months and seven days with

your first day of last menstrual period. That will be yours expected date of delivery. But, only 4%

pregnant women start labor-pain on that expected date. If everything runs well, almost 80% women

deliver within 2 weeks earlier and one week later of that date.

Curtail: Curtail strenuous physical exercise, prolonged standing, scuba diving and long on road journey.

Curtail tension, anxiety and stress. Stop dieting. Stop smoking and drinking. Cycling, swimming, walking

and low-impact aerobics are recommended in uncomplicated pregnancy.

Diagnose: Diagnose day by day the symptoms of pregnancy in your-self. Nausea and vomiting will be

there as well as loss of appetite. Urinary frequency will be increased. There will be sensation of

heaviness of breasts. Backache, constipation and leg cramps are also common symptoms in gravid state.

These are actually your body’s response to accommodate your growing fetus.

Examine: Examine your body parts in closed door. Look at your breasts. They will become pigmented,

tender and enlarged along with some secretions. You will feel a gradual bulge in lower abdomen. Your

vagina may become soft. You may notice excessive non-irritant mucoid vaginal discharge time to time.

Don’t panic. These are absolutely normal findings.

Follow: Follow healthy dietary tips. Follow a habit of drinking adequate water. Ensure your diet is

balanced and healthy enough. Ensure adequate sleep. Light free hand exercises or sexual activities can

be allowed. Start to take folic acid 5 mg once a day.

Guard: Guard your growing fetus. Be conscious. Few offending agents can seriously hamper fetal

growth. Guard your pregnancy from radiation exposure if you are working in a radiology or oncology

clinic. Few medications like antihypertensive ACE inhibitors, antithyroid drugs, anticancer drugs, lithium

etc can adversely influence the development. Are you having these medications? Please check the list

www.just.edu.jo/DIC/…/Drugs%20contrandicated%20in%20pregnancy

Some Other Symptoms in Early Pregnancy

Hurry: Hurry, if you experiences following symptoms in early pregnancy.

 Excessive vomiting with decreased urination

 Bleeding per-vagina

 Burning micturation

 Persistent headache with blurring of vision

 Respiratory distress

Do not deal these ailments casually. Also report if you have persistent pain abdomen.

Inform: Inform your close circle regarding your gravid state. This is vital. Don’t keep it secret. If any

emergency arises by any chance, then they can help you accordingly.

Judge: Finally, judge yourself. Are you diabetic, hypertensive or asthmatic and on any form of regular

medications? Do you have experienced miscarriage last time? Are you a post-surgical patient? Actually

are you healthy enough or are you a high-risk mother? 20-30% pregnancies belong to high risk category.

This type of pregnancy needs an early consultation. Following are considered as high-risk pregnancy.

Pregnancy High-Risk Group

Check whether you are included in the high-risk group.

 Pregnancy with a previous history of repeated abortions or still-births

 Pregnancy in women aged < 16 years or >35 years

 Pregnancy with previous history of pregnancy complications like preterm

labor, hypertensive disorder, previous Caesarean section etc.

 Pregnancy in woman who’s blood group is Rhesus negative

 Pregnancy in a woman suffering from medical disorders like hypertension,

heart disease, epilepsy, asthma, thyroid disorders or renal disease.

molar pregnancy

Grapes Are Inside My Uterus and Not a Baby! It Is Hydatidiform Mole.

You are pregnant with all its symptoms and signs….but an ultrasonography done following one episode of bleeding per vagina revealed there is no fetus inside. The uterus is full of vesicles like bunch of grapes!! This condition occurs in one out of 1200 pregnancies where the placenta changes into grape like structutes.There is no fetus inside and if present, it is small and malformed.

There will be bleeding per vagina, sometimes with passage of grape-like vesicles in a four months pregnant lady

Clinically this condition presents as sudden bleeding per vagina mixed with vesicles following a period of missed period along with pain abdomen. There may be increased nausea and vomiting in her early pregnancy-period. Size of the pregnant uterus is often more than the period of amenorrhea. Features of thyroid disorders are often seen as this grapes sometime secret thyroid hormone.

Diagnosis is confirmed by ultrasonography of uterus and increased hormone beta-hCG level in blood.

Ultrasonography shows moles inside uterus, sometimes along with enlarged ovaries. There will be no fetus or fetal heart sounds. Sometimes a small or malformed fetus is found surrounded by grapes. This condition is called partial molar pregnancy. Level of beta-hCG, a pregnancy hormone, will be very high in contrast to normal pregnancy.

Urgent Evacuation of Uterus by Suction Is Mandatory

This growing mole can cause massive vaginal bleeding, even can perforate uterus. It can even endanger life by transporting to lungs and other organs through blood. So you need an urgent management of this condition to avoid complications. Gentle suction through vagina is the mode for evacuation. Risk of bleeding is also there while doing the evacuation process. Chance of infection is also there.

Though this condition is benign—3-4% cases turn cancerous called choriocarcinoma

This is a benign disease. But rarely might it turn malignant. In 1-4% cases recurrence also occur in subsequent pregnancy.   So be particular for a methodical follow up.

Who are the high-risk candidates for developing cancer following H-mole?

They are the women who have any or multiple risk factors mentioned below.

• Age more than 45 years
• Three or more previous birth
• Previous history of molar-pregnancy
• Uterus more than 20 weeks size
• Initial high serum hCG> 1,00000 mIU/ml

Follow-Up Visit Is Mandatory

Frequent follow up with general work out along with three weekly blood beta-hCG estimation is mandatory to diagnose persistence of disease or to rule out any malignant transformation. Look for any of these symptoms/signs in post-abortal period

• Irregular persistent bleeding per vagina
• Growth or mass around genitalia
• Persistent pain abdomen
• Respiratory difficulty

Often a follow up chest x-ray is recommended to find any lung metastasis.

Decision regarding timing of next pregnancy is vital

A second pregnancy within a short interval following a molar is catastrophic. You have to wait for one year or six months following normalization of beta-hCG levels, which one is later. Otherwise a chance of recurrence is there.

Low-dose combined contraceptive pills can be used meantime

Contraception is needed following suction-evacuation and low dose pills can be opted for this. Intrauterine devices could not be recommended for fear of perforation of soft uterus.