Pregnancy
Pregnancy is the fertilization and development of one or more
offspring, known as an embryo or fetus, in a woman's uterus. In a pregnancy,
there can be multiple gestations, as in the case
of twins or triplets. Childbirth usually occurs about 38 weeks after conception;
in women who have a menstrual cycle length of four weeks, this is approximately
40 weeks from the start of the last normal menstrual period (LNMP). Human
pregnancy is the most studied of all mammalian pregnancies. Conception can be
achieved through sexual intercourse or assisted reproductive technology.
An embryo is the developing offspring during the
first 8 weeks following conception, and subsequently the term fetus is used henceforth until birth. 40% of pregnancies in the United
States and United Kingdom are unplanned, and between a quarter and half
of those unplanned pregnancies were unwanted pregnancies.
In many
societies’ medical or legal definitions, human pregnancy is somewhat
arbitrarily divided into three trimester periods, as a means to simplify
reference to the different stages of prenatal development. The first trimester
carries the highest risk of miscarriage (natural
death of embryo or fetus). During the second trimester, the development of the
fetus can be more easily monitored and diagnosed. The beginning of the third
trimester often approximates the point of viability, or the ability of the fetus to
survive, with or without medical help, outside of the uterus.
Complications of pregnancy
Complications
of pregnancy are the symptoms and
problems that are associated with pregnancy. There are both routine problems and serious, even
potentially fatal problems. The routine problems are normal complications, and
pose no significant danger to either the woman or the fetus. Serious problems can cause both maternal death and fetal death if
untreated.
Back pain
§
Common,
particularly in the third trimester when the patient's center of gravity has
shifted.
§
Treatment: mild
exercise, gentle massage, heating pads, paracetamol (acetaminophen),
and (in severe cases) muscle
relaxants or narcotics
Carpal tunnel syndrome
§
Occurs in
between an estimated 21% to 62% of cases, possibly due to edema.
Constipation
§
Cause:
decreased bowel motility secondary to elevated progesterone (normal
in pregnancy), which causes the "smooth muscle"
along the walls of the intestines to relax. Thus, making sure that the future
mother will absorb as much nutrients from her diet as possible in order to nourish
the fetus and
herself. As a side effect the feces can get extremely dehydrated and hard to
pass.
§
Treatment:
increased PO fluids, stool softeners, bulking
agents Drinking plenty of water and eating fruit and fiber
enriched foods often help
A woman experiencing sudden defecation should
report this to her practitioner.
Contractions
§
occasional,
irregular, painless contractions that occur several times per day are normal
and are known as Braxton Hicks contractions
§
Caused by:
dehydration
§
Treatment: fluid
intake
§
regular
contractions (every 10-15 min) are a sign of preterm labor and
should be assessed by cervical exam.
Dehydration
§
Caused by:
expanded intravascular space and increased Third spacing of fluids
§
Treatment: fluid
intake
§
Complication: uterine
contractions, which may occur because dehydration causes body release of ADH, which is similar to oxytocin in
structure. Oxytocin itself can cause uterine contractions and thus ADH can
cross-react with oxytocin receptors and also cause contractions.
Edema
§
Caused by:
compression of the inferior vena cava (IVC) and pelvic veins
by the uterus leads
to increased hydrostatic pressure in lower extremities.
§
Treatment: raising
legs above the heart, patient sleeps on her side.
Gastroesophageal Reflux Disease (GERD)
§
Caused by:
relaxation of the lower esophageal sphincter (LES) and
increased transit time in the stomach (normal in pregnancy)
§
Treatment:
antacids, multiple small meals a day, avoid lying down within an hour of
eating, H2 blockers, proton pump inhibitors
Hemorrhoids
§
Caused by:
increased venous stasis and IVC compression leading to congestion in venous
system along with increased abdominal pressure secondary to constipation.
§
Treatment: topical
anesthetics, steroids, treatment of constipation
Pica
§
cravings
for nonedible items such as dirt or clay. Caused by Iron deficiency which is
normal during pregnancy and can be overcome with Iron supplements or prenatal
vitamins. Commonly, avoid ice chips; it may worsen anemia
Lower abdominal pain
§
Caused by: rapid
expansion of the uterus and stretching of ligaments such as the round
ligament.
§
Treatment: paracetamol (acetaminophen)(kulot)
Increased urinary frequency
§
Caused by:
increased intravascular volume, elevated GFR (glomerular filtration rate), and
compression of the bladder by the expanding uterus. Patients
are advised to continue fluid intake despite this. Urinalysis and
culture should be ordered to rule out infection, which can also cause increased
urinary frequency but typically is accompanied by dysuria(pain
when urinating).
Varicose veins
§
Caused by:
relaxation of the venous smooth muscle and
increased intravascular pressure.
§
Treatment:
elevation of the legs, pressure stockings
§
relieve
swelling and pain with warm sitz bath.
§
Avoid
obesity, lengthy standing or sitting, constrictive clothing and constipation
and bearing down with bowel movements
Diastasis recti or abdominal separation
During pregnancy, many women
experience a separation of their stomach muscles, known as diastasis recti. In
order to understand this condition, it is important to understand the muscle
that it affects. This particular condition affects the rectus abdominis muscle,
that muscle that gives you a “six pack”. (See figure)
The rectus abdominis muscle is
divided down the middle by the tendinous line called the linea alba.[3] It
is kept in line by your transverse abdominal and your oblique abdominal
muscles. During pregnancy, the growth of the fetus exerts pressure on abdominal
cavity muscles, in particular the rectus abdominis. In pregnancies that
experience rapid fetus growth or women with particularly weak abdominal
muscles, this pressure can sometimes causes the rectus abdominis muscle to
separate along the linea alba, creating a split between the left and right
sides of the rectus abdominis.
About one-third of all pregnant
women experience diastasis recti at some point in their pregnancy, however it
is much more likely to occur during the second trimester or third trimester of
pregnancy. However, separation also frequently occurs during labor and
delivery, or with women carrying more than one baby. Many
cases of diastasis recti correct themselves after birth, but some do not. In
cases where it persists, exercise may help improve the condition, and sometimes
surgery is needed to correct the problem to prevent pain and future
complications.
congenital disorder
A congenital
disorder, or congenital
disease, is a condition existing at birth and often before birth, or that
develops during the first month of life (neonatal disease), regardless of causation. Of
these diseases, those characterized by structural deformities are termed "congenital anomalies"; that is a
different concept which involves defects in or damage to a developing fetus.
A congenital
disorder may be the result of genetic abnormalities, the intrauterine (uterus) environment,
errors of morphogenesis,infection, or a chromosomal abnormality. The outcome of the
disorder will depend on complex interactions between the pre-natal deficit and the post-natal environment Animal studies indicate that the
mother's (and possibly the father's) diet, vitamin intake, and glucose levels prior to ovulation and conception have long-term effects
on fetal growth and adolescent and adult disease Congenital disorders vary widely in
causation and abnormalities. Any substance that causes birth defects is known
as a teratogen.
The older term congenital disorder does not necessarily refer to
a genetic disorder despite the similarity of the words.
Some disorders can be detected before birth through prenatal diagnosis (screening).
Neonatal Care
A neonatal
intensive care unit (NICU)
is an intensive care unit specializing in the care of ill or premature newborn infants. The first
official ICU for neonates was founded in 1961 at Vanderbilt University by Dr.
Mildred Stahlman, officially termed a NICU when Dr. Stahlman used a ventilator
off-label for a baby with breathing difficulties, for the first time ever in
the world.
A NICU is
typically directed by one or more neonatologists and staffed by nurses, nurse practitioners, pharmacists, physician assistants, resident physicians,
and respiratory therapists. Many other
ancillary disciplines and specialists are available at larger units. The term neonatal comes from neo, "new", and natal, "pertaining to
birth or origin".
