combined pregnancy
pregnancy
[preg´nan-se]Other signs of pregnancy include softening of the cervix and filling of the cervical canal with a plug of mucus. Early in labor this plug is expelled and there is slight bleeding; expulsion of the mucous plug is known as show" >show and indicates the beginning of cervical dilatation. chadwick's sign" >chadwick's sign of pregnancy refers to a bluish color of the vagina which is a result of increased blood supply to the area.
When the abdominal wall becomes stretched there may be a breaking down of elastic tissues, resulting in depressed areas in the skin which are smooth and reddened. These markings are called striae gravidarum" >striae gravidarum. In subsequent pregnancies the old striae appear as whitish streaks and frequently do not disappear completely.
There are several fairly accurate laboratory tests for pregnancy; all are designed to detect human gonadotropin" >chorionic gonadotropin (hCG), a hormone produced by living chorionic placental tissue and evident in the blood and urine of pregnant women. See also pregnancy tests.
There is now less emphasis on severe restriction of the mother's dietary intake to maintain a limited weight gain. The average gain is about 28 lb during pregnancy, and either starvation diets or forced feedings can be unhealthy for the mother and hazardous for the fetus. Ideally, the mother should achieve normal weight before she becomes pregnant because obesity increases the possibility of eclampsia and other serious complications of pregnancy. Mothers who are underweight are more likely to deliver immature babies who, by virtue of their physiologic immaturity, are more likely to suffer from birth defects, hyaline membrane disease, and other developmental disorders of the newborn.
Other factors affecting the fetus include certain drugs taken by the mother during pregnancy. A well-known example is thalidomide, which inhibits the growth of the extremities of the fetus, resulting in gross deformities. Many drugs, including prescription as well as nonprescription medications, are now believed to be capable of causing fetal abnormalities. In addition, consumption of alcohol during pregnancy may result in fetal alcohol syndrome. Most health care providers recommend that all drugs be avoided during pregnancy except those essential to the control of disease in the mother.
Diseases that increase the risk of obstetrical complications include diabetes, heart disease, hypertension, kidney disease, and anemia. rubella" >rubella (German measles) can be responsible for many types of birth defects, particularly if the mother contracts it in the first 3 months of pregnancy. Sexually transmitted diseases can have tragic effects on the baby, even though the symptoms in the mother are minor at the time of pregnancy. syphilis is particularly dangerous because it is one of the few diseases that can be transmitted to the fetus in utero. The baby is either stillborn or born infected, and rarely escapes physical or mental defects or both. Successful treatment of the mother before the fifth month of pregnancy will prevent infection in the infant.
During the birth process the infant may be infected with gonorrhea as it passes through the birth canal. Gonorrheal infection of the eyes can cause blindness. herpes simplex Type II involving the genitals of the mother can also be transmitted to the infant at birth. The mortality and morbidity rates for such infected infants are high.
The age of the mother is also an important factor in the well-being of the fetus. The mortality and morbidity rate for infants born of mothers below age 15 and above 40 are higher than for those of mothers between these ages.
Recently developed tests to monitor fetal health have taken much of the guesswork out of predicting the chances of survival and health status of the fetus after birth. Such tests and evaluation techniques include amniocentesis, chemical and hormonal assays, biophysical profiles, testing for alpha-fetoprotein, ultrasound examinations, electronic surveillance of fetal vital signs and reaction to uterine contractions, and analyses of the infant's blood during labor.
On the first prenatal visit the patient's medical history is taken in considerable detail, including any diseases or operations she has had, the course of previous pregnancies, if any, and whether there is a family history of multiple births or of diabetes mellitus or other chronic diseases. The first visit also includes a thorough physical examination and measurement of the pelvis. Blood samples are taken for screening for rubella and sexually transmitted diseases such as syphilis, hepatitis B, chlamydiosis, infection by the human immunodeficiency virus, and other conditions. A complete blood count is also needed. Urine is tested for albumin and sugar and examined microscopically. On subsequent visits the patient brings a urine specimen, collected upon arising that morning, to be tested for albumin and glucose. At each prenatal visit her blood pressure is taken and recorded and she is weighed. In the second trimester, when the uterus becomes an abdominal organ, the height of the fundus is measured at each visit. After the sixth month a rule such as mcdonald's rule can be applied to assess fetal growth.
Patients who are considered high-risk mothers usually are sent to a specialist and the infant is delivered at a regional hospital where sophisticated monitoring equipment and laboratory tests are available, and specially trained personnel can attend to the needs of the mother and her infant.
A visit to a dentist early in pregnancy is a good idea to forestall any possibility of infection arising from tooth decay. Pregnancy does not encourage tooth decay. Hemorrhoids sometimes occur in pregnancy because of pressure from the enlarged uterus on the veins in the rectum. The health care provider should be consulted for treatment. varicose veins also result from pressure of the uterus, which restricts the flow of blood from the legs and feet. Lying flat with the feet raised on a pillow several times a day will help relieve swelling and pain in the legs. In more difficult cases the health care provider may prescribe an elastic bandage or support stockings.
Backache during pregnancy is caused by the heavy abdomen pulling on muscles that are not normally used, and can be relieved by rest, sensible shoes, and good posture. Swelling of the feet and ankles usually is relieved by rest and by remaining off the feet for a day or two. If the swelling does not disappear, the health care provider should be informed since it may be an indication of a more serious complication.
Shortness of breath is common in the later stages of pregnancy. If at any time it becomes so extreme that the woman cannot climb a short flight of stairs without discomfort, the health care provider should be consulted. If a mild shortness of breath interferes with sleep, lying in a half-sitting position, supported by several pillows, may help.
The more serious complications of pregnancy include pyelitis, hyperemesis gravidarum, eclampsia, and placenta previa and abruptio placentae.
In a tubal pregnancy a spontaneous abortion may occur, but more often the fetus will grow to a size large enough to rupture the tube. This is an emergency situation requiring immediate treatment. The symptoms of such a tubal rupture are vaginal bleeding and severe pain in one side of the abdomen. Prompt surgery is necessary to remove the damaged tube and the fetus, and to stop the bleeding. Fortunately, the removal of one tube usually leaves the other one intact, so that future pregnancy is possible. Patients who are Rh-negative should be given Rh0 (D) immune globulin (RhoGAM) after ectopic pregnancy for isoimmunization protection in future pregnancies.
