We conduct prenatal Yoga on weekends Fridays and Saturdays from 11.00 am – 12.00 noon and on weekdays from 06.00 pm – 07.00 pm twice or thrice a week based on demand. We have a schedule for mornings as well based on demand. Our prenatal Yoga is also booked as a private session in cases of complications.

Gems Of Yoga prenatal yoga is accessible to all women, whether or not they have practice yoga before. There will be the adaption of classic yoga with micro=movements and flow sequences. Caring, relaxed and nurturing classes. Yoga is highly recommended to pregnant women because it is a gentle way of maintaining fitness while reducing anxiety with breathing and relaxation techniques. Gems Of Yoga practices are science=based but taught from the heart to nurture the whole person”. We follow Satyananda Yoga technques combined with the wisdom of Francoise Barbara Freedmen.

WE HAVE BEEN HANDLING PRENATAL YOGA FOR LAST 18 YEARS AND HAVE BEEN ABLE TO GIVE GOOD RESULTS AS LONG AS YOU KEEP THE FREQUENCY OF 3 TIMES PER WEEK. AFTER PRENATAL YOGA POSTNATAL YOGA CAN BE DONE.

Yoga is safe during pregnancy and can be safely practiced with the right teacher.

What Is Pregnancy Planning?

Planning for pregnancy typically involves discussions with a woman’s partner and her health-care team, and includes discussions about nutrition and vitamins, exercise, genetic counseling, weight gain, and the need to avoid certain medications and alcohol. However, because some women experience light bleeding known as implantation bleeding around the time of the expected menstrual period, or because of irregular menstrual cycles, some women may not realize they are pregnant until specific symptoms of pregnancy start to develop. By this time, the woman may have unknowingly exposed herself to substances that may be harmful for the pregnancy.

Women who choose to begin pregnancy planning before conception can take steps to ensure that potentially harmful exposures are avoided.

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What is pregnancy planning?

Pregnancy planning begins even before conception for many women. Others choose to start planning when they are aware of a pregnancy. While it is possible to have a healthy pregnancy and baby without a pregnancy plan, developing a pregnancy plan is one way to help ensure that your baby has the greatest chances of having good health and that you have a healthy pregnancy.

Planning for pregnancy typically involves:

• Discussions with a woman’s partner and her health-care team, and includes discussions about nutrition and vitamins, exercise, genetic counseling, weight gain, and the need to avoid certain medications and alcohol.
• Sometimes, planning for pregnancy includes fertility planning and scheduling sexual intercourse for the time of the month when the woman is most fertile. Couples who are having regular sexual intercourse and who still do not conceive typically consult a fertility specialist. Doctors generally recommend that healthy couples in which the woman is under 35 try to get pregnant for a year before consulting a fertility specialist. Women over 35 may want to consult a fertility specialist after 6 months of trying to conceive.
• Because some women experience light bleeding known as implantation bleeding around the time of the expected menstrual period , or because of irregular menstrual cycles, some women may not realize they are pregnant until specific symptoms of pregnancy start to develop. By this time, the woman may have unknowingly exposed herself to substances that may be harmful for the pregnancy. Women who choose to begin pregnancy planning before conception can take steps to ensure that potentially harmful exposures are avoided.

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What are the goals pre-pregnancy planning?

Share your story:

Before a woman becomes pregnant she can discuss her medical history with a doctor, focusing on the following:

• Chronic medical conditions like diabetes, hypo or hyper Thyroidism, uric acid or kidney problems, or cardiac problems should be monitored and well controlled prior to conception for the greatest chances of a healthy pregnancy.
• Women may be tested to determine if they have been infected with the hepatitis B or HIV viruses, so that appropriate treatment during pregnancy or at delivery can help prevent transmission of the infections to the baby.
• Immunization history and immune response to Varisella (Chickenpox) and rubella (German Measles): the status of a woman’s immunity to these two infections, which can cause harm to the developing fetus can be determined by a blood test. If a woman is not immune to these infections, vaccination can be given before trying to conceive. After receiving the varicella Vaccine, women should wait 30 days before attempting conception. Precautions against developing certain other infections should also be taken.
• Couples who have a history of inherited diseases, have other children with genetic diseases, or who have family histories of certain conditions may choose to undergo genetic counseling prior to conception. Your doctor can help you determine whether genetic counseling is appropriate for you.

Stopping to Smoke dramatically improves the chances of a healthy pregnancy, and women planning pregnancy should abstain from alcohol use. Those with substance Abuse problems should ideally be identified and treated prior to planning a pregnancy.

Calculating Your Estimated Due Date

One simple and common method for calculating your delivery date is as follows:

• Mark down the date when your last period started.
• Add seven days.
• Count back three months.
• Add a whole year.

Expecting Twins or Triplets

How do multiple pregnancies occur?

A multiple pregnancy occurs when one egg (ovum) splits before implanting or when separate eggs are each fertilized by a different sperm.

Identical twins or triplets occur with the fertilization of a single egg that later divides into two or three identical embryos. Identical twins or triplets have the same genetic identity, are always the same sex, and look almost exactly the same.

Fraternal multiples develop from separate eggs that are each fertilized by a different sperm. Fraternal twins might or might not be of the same sex and might not necessarily resemble each other any more than two siblings from the same parents might.

In a pregnancy with triplets or more, the babies can be all identical, all fraternal, or a mixture of both. This can happen when multiple eggs are released by the mother and fertilized. If one or more of these fertilized eggs divides into two or more embryos, a mixture of identical and fraternal multiples will occur.

FAQ For Prenatal Yoga

1.    How can I follow a vegetarian meal plan safely during pregnancy?

Types of vegetarians

• Vegan — This diet includes fruits, vegetables, beans, grains, seeds, and nuts. All animal sources of protein — including meat, poultry, fish, eggs, milk, cheese, and other dairy products — are excluded from the diet.
• Lacto-vegetarian — This diet includes dairy products in addition to the foods listed above in the vegan diet. Meat, poultry, fish, and eggs are excluded from the diet.
• Lacto-ovo-vegetarian — This diet includes dairy products and eggs in addition to the foods listed above in the vegan diet. Meat, poultry, and fish are excluded from the diet.
• Pescatarian — This diet includes dairy products and eggs in addition to the foods listed above in the vegan diet. Meat and poultry are excluded from the diet, but fish is permitted, focusing on the fattier omega-3 rich varieties.Congratulations! You are now eating for you and your baby. While there are 2 of you now, you only need to increase your calorie intake by 500 calories. This guide will help you choose a variety of healthy foods for you and your baby to get all the nutrients you need.

What foods should I eat?

• You will need an additional 200 to 300 extra calories from nutrient-dense foods such as lean meats, low fat dairy, fruits, vegetables and whole grain products. It will be important to carefully consider the foods you consume during your pregnancy. This is a time to eat more foods that are nutrient-dense, and fewer sweets and treats. Eat a variety of foods.

2. Vegetarian nutrition during pregnancy
   A. Research verifies that vegetarian diets can be nutritionally adequate in pregnancy.

During pregnancy, it is important to choose a variety of foods that provide enough protein, calories, and nutrients for you and your baby. Depending on the type of vegetarian meal plan you follow, you might need to adjust your eating habits. Follow the guidelines below for healthy vegetarian eating during pregnancy.

It is also important to choose safe foods and prepare foods safely because pregnant women are at increased risk of food poisoning.

Goals for healthy eating

• During pregnancy, you don’t need extra calories for the first three months. During the last six months, normal-weight women need an extra 300 calories from nutrient-rich foods to help the baby grow.
• Eat a variety of foods to get all the nutrients you need. The “Vegetarian Foods to Choose” chart below provides the number of servings to eat from each food group every day.
• Choose foods high in complex carbohydrates and fiber such as whole grain breads, cereals, pasta, rice, fruits, and vegetables.
• Eat and drink at least four servings of calcium-rich foods a day to help ensure that you are getting 1200 mg of calcium in your daily diet. Sources of calcium include dairy products, fortified non-dairy milks (i.e., almond, soy, coconut), seafood with bones, leafy green vegetables, dried beans or peas, and tofu.
• Vitamin D will help your body use calcium. Adequate amounts of vitamin D can be obtained through exposure to the sun and in fortified milk, eggs, and fish. Vegans should receive 10 to 15 minutes of direct sunlight to the hands, face, or arms three times per week, or take a supplement as prescribed by their health care providers. Vitamin D3 (cholecalciferol) is of animal origin and is obtained through the ultraviolet irradiation of 7-dehydrocholesterol from lanolin. Vitamin D2 (ergocalciferol) is produced from the ultraviolet irradiation of ergosterol from yeast and is acceptable to vegans.
• Eat at least three servings of iron-rich foods per day to ensure you are getting 27 mg of iron in your daily diet. Sources of iron include enriched grain products (cereal, pasta, rice), eggs, leafy green vegetables, sweet potatoes, dried beans and peas, raisins, prunes, and peanuts.
• Choose at least one source of vitamin C every day. Sources of vitamin C include citrus fruits (oranges, grapefruits, lemons, limes), strawberries, honeydew, broccoli, cauliflower, Brussels sprouts, green peppers, baked potatoes, tomatoes, and mustard greens.
• Choose at least one source of folic acid every day. Sources of folic acid include whole grains, fortified cereals and grains, dark, green, leafy vegetables, and legumes such as lima beans, black beans, black-eyed peas, and chickpeas.
• Choose at least one source of vitamin A every other day. Sources of vitamin A include carrots, pumpkins, sweet potatoes, spinach, squash, turnip greens, beet greens, apricots, and cantaloupe.
• Choose at least one source of vitamin B12 a day. Vitamin B12 is found in animal products only. including fish and shellfish, eggs, and dairy products. No unfortified plant food contains any significant amount of active vitamin B12. For vegans, vitamin B12 must be obtained from regular use of vitamin B12-fortified foods, such as fortified soy and rice beverages, some breakfast cereals, and meat analogs. Vegans are at risk of vitamin B12 deficiency. For vegans, B12 can be obtained from nutritional yeast; otherwise, a daily vitamin B12 supplement is needed.
• Avoid alcohol during pregnancy. Alcohol has been linked to premature delivery and low birth weight babies. If you think you might have a problem with alcohol use, please talk to your health care provider so he or she can help protect you and your baby.
• Limit caffeine to no more than 300 mg per day (two 5-ounce cups of coffee, three 5-ounce cups of tea, or two 12-ounce glasses of caffeinated soda). Remember, chocolate contains caffeine — the amount of caffeine in a chocolate bar is equal to 1/4 cup of coffee.
• The use of non-nutritive or artificial sweeteners approved by the Food and Drug Administration (FDA) is acceptable during pregnancy. These FDA-approved sweeteners include aspartame and acesulfame-K. The use of saccharin is strongly discouraged during pregnancy because it can cross the placenta and might remain in fetal tissues. Talk with your health care provider about how much non-nutritive sweetener is acceptable during pregnancy.
• DO NOT DIET or try to lose weight during pregnancy. Both you and your baby need the proper nutrients in order to be healthy. Keep in mind that you will lose some weight the first week after your baby is born.

3.    Breads and grains

1. 9 or more servings/day

• 1 slice of bread
• 1/2 bagel or English muffin
• 1 rice cake
• 6 crackers (such as matzo, bread sticks, rye crisps, saltines, or 3 graham crackers)
• 3/4 cup ready-to-eat cereal
• 1/2 cup pasta or rice
• Small plain baked potato
• 1 small pancake
• 1 6-inch tortilla

4.    Fruits and vegetables

1. 4 or more servings/day of vegetables; 3 or more servings of fruit

• 3/4 cup fruit juice or 1/2 cup vegetable juice
• 1 piece fresh fruit
• 1 melon wedge
• 1/2 cup chopped, cooked, or canned fruit
• 1/2 cup cooked or canned vegetables
• 1 cup chopped, uncooked vegetables

5.    Dairy

1. 4 or more servings/day

• 1 cup low-fat milk or fortified almond, coconut, or soy milk
• 1 cup low-fat yogurt
• 1 1/2 ounces of cheese
• 1/2 cup of cottage cheese

6.    Protein

1. 3 servings per day

• 1/2 cup cooked dried beans or peas
• 1/2 cup tofu
• 1/4 cup nuts or seeds
• 2 tablespoons of peanut butter
• 1 egg or 2 egg whites

7.    Fats and oils (healthy liquid unsaturated oils preferred)

1. Approximately 8-12 tsp./day

• Olive, sesame, grapeseed, flaxseed, canola, or peanut oils
• Tub margarine, salad dressings, and spreads made from trans fat-free liquid oils (or water) as the first ingredient
• 2 tablespoons nuts

8.    Sweets and snacks

1. In limited amounts

• Fat-free baked goods
• Sherbet, sorbet, Italian ice, popsicles
• Low-fat frozen yogurt
• Angel food cake
• Fig bars
• Gingersnaps
• Jelly beans, hard candy
• Plain popcorn
• Pretzels

9.    Seafood nutrition and seafood safety

1. Seafood is a rich source of omega-3 fatty acids, a type of essential fatty acid. Many studies suggest that these fats, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are beneficial to both moms and the babies. Eating seafood is encouraged and supported by the Academy of Nutrition and Dietetics and the American College of Obstetrics and Gynecologists.

Recommended intake goals are for 8-12 ounces per week of low-mercury, low-contaminant seafood. For food safety information for locally caught fish, please contact the local health department or the Environmental Protection Agency.

10.Seafood to eat and to avoid

1. Eat (eight to 12 ounces per week)

• Anchovies
• Bass (striped and freshwater)
• Canned LIGHT tuna
• Cod
• Crab
• Halibut
• Herring
• Mussels
• Oysters
• Pollock
• Salmon
• Sardines
• Shrimp
• Tilapia
• Trout
• Whitefish

LIMIT to 6 ounces per week

• Albacore or “white” tuna; fresh bluefin or yellowfin

Avoid: Do NOT eat

• Shark
• Swordfish
• King mackerel
• Tilefish
• Raw fish (including sushi, sashimi, ceviche, and carpaccio) due to food poisoning risk
• Refrigerated smoked seafood due to listeria risk

11.Food safety

1. Food safety is important for all pregnant women, including vegetarians. Produce, grains, and dairy can pose risks.

Take the following precautions for these food groups:

• Produce — Wash all fruits and vegetables before cutting them. Do not consume unpasteurized juices (fruit or vegetable) or raw bean, alfalfa, or clover sprouts.
• Grains — Do not eat raw grains or raw sprouted grains.
• Protein foods — Do not eat raw or undercooked eggs, tofu, miso and tempeh products (unless cooked to more than 140 degrees in a dish), or raw nuts.
• Dairy — Do not consume unpasteurized milk or cheeses made from unpasteurized milk (unless cooked to more than 140 degrees), unrefrigerated dairy desserts/cream, or cheese-filled pastries and pies.
• Beverages — Do not consume mate tea or sun tea (sun-brewed), or iced tea brewed with warm or cold water.
• Miscellaneous — Do not consume raw or unpasteurized honey, raw yeast, raw cookie dough/cake batter, any outdated or moldy foods, or salad dressings made with raw egg.

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Fetal Development: Stages of Growth

The start of pregnancy is actually the first day of your last menstrual period. This is called the ‘menstrual age’ and is about two weeks ahead of when conception actually occurs.

Here’s a primer on conception

Each month a group of eggs (called oocytes) is recruited from the ovary for ovulation (release of the egg). The eggs develop in small fluid-filled cysts called follicles. Normally, one follicle in the group is selected to complete maturation. This dominant follicle suppresses all the other follicles in the group, which stop growing and degenerate.

The mature follicle opens and releases the egg from the ovary (ovulation). Ovulation generally occurs about two weeks before a woman’s next menstrual period begins.

After ovulation, the ruptured follicle develops into a structure called the corpus luteum, which secretes progesterone and estrogen. The progesterone helps prepare the endometrium (lining of the uterus) for the embryo to implant.

On average, fertilization occurs about two weeks after your last menstrual period. When the sperm penetrates the egg, changes occur in the protein coating around it to prevent other sperm from entering. At the moment of fertilization, your baby’s genetic make-up is complete, including its sex.

If a Y sperm fertilizes the egg, your baby will be a boy; if an X sperm fertilizes the egg, your baby will be a girl.

Human chorionic gonadotrophin (hCG) is a hormone present in your blood from the time of conception. It is produced by cells that form the placenta and is the hormone detected in a pregnancy test. However, it usually takes three to four weeks from the first day of your last period for the hCG to increase enough to be detected by pregnancy tests.

Within 24 hours after fertilization, the egg begins dividing rapidly into many cells. It remains in the fallopian tube for about three days. The fertilized egg (called a blastocyte) continues to divide as it passes slowly through the fallopian tube to the uterus where its next job is to attach to the endometrium (a process called implantation). Before this happens, the blastocyte breaks out of its protective covering. When the blastocyte establishes contact with the endometrium, an exchange of hormones helps the blastocyte attach. Some women notice spotting (or slight bleeding) for one or two days around the time of implantation. The endometrium becomes thicker and the cervix is sealed by a plug of mucus.

Within three weeks, the blastocyte cells ultimately form a little ball, or an embryo, and the baby’s first nerve cells have already formed. Your developing baby is called an embryo from the moment of conception to the eighth week of pregnancy. After the eighth week and until the moment of birth, your developing baby is called a fetus.

The development stages of pregnancy are called trimesters, or three-month periods, because of the distinct changes that occur in each stage.

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For example, if the first day of your last period was September 9, 2018, adding 7 days will make the date September 16, 2018. Counting back 3 months results in the date of June 16. Finally, adding a year yields an estimated delivery date of June 16, 2019.

The above strategy is based on the assumption that conception occurred 14 days after the start of your last menstrual period. Also, it’s important to remember that no matter what “pen and paper” calculations you use to estimate your delivery date, these methods are just that – estimates. Most babies are born between 38 and 42 weeks (the normal pregnancy is considered to be 40 weeks in length counting from the first day of your last menstrual cycle) and only a small percentage of women actually deliver on their estimated due date.

Your doctor can use other methods to provide you with your delivery date, such as conducting an ultrasound examination in the first trimester. It is advised that a physical  exam be done.

Pregnancy and Bladder Control

Many women experience urine leakage, which is also called incontinence, during pregnancy or after they have given birth.

The bladder is a round, muscular organ that is located above the pelvic bones. It is supported by the pelvic muscles. A tube called the urethra allows urine to flow out of the bladder. The bladder muscle relaxes as the bladder fills with urine, while the sphincter muscles help to keep the bladder closed until you are ready to urinate.

There are other systems of the body that help to control the bladder. Nerves from the bladder send signals to the brain when the bladder is full, and nerves from the brain signal the bladder when it needs to be emptied. All of these nerves and muscles must work together so the bladder can function normally.

How do pregnancy and child birth affect bladder control?

During pregnancy, you may leak urine between trips to the bathroom. You may find that this is especially true when you cough, laugh, sneeze, or do other physical activities that put stress on the pelvic floor muscles. This type of leakage is called stress incontinence. During pregnancy, the unborn baby puts pressure on the pelvic floor muscles, bladder, and urethra. The extra pressure can make you feel the urge to urinate more often. Stress incontinence may be only temporary and often ends within a few weeks after the baby is born.

Pregnancy, the type of delivery, and the number of children a woman has are factors that can increase the risk of incontinence. Women who have given birth, whether by vaginal delivery or cesarean section, have much higher rates of stress incontinence than those who never have had a baby.

Loss of bladder control may be caused by pelvic organ prolapse that sometimes occurs after childbirth. The pelvic muscles can stretch and become weaker during pregnancy or vaginal delivery. If the pelvic muscles do not provide enough support, your bladder may sag or droop. This condition is known as a cystocele. When the bladder sags, it can cause the urethra’s opening to stretch.

Pelvic nerves that regulate bladder function may be injured during a long or difficult vaginal delivery. Delivery with forceps can result in injuries to the pelvic floor and anal sphincter muscles. Prolonged pushing during a vaginal delivery also increases the likelihood of injury to the pelvic nerves and subsequent bladder control problems.

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Pregnancy: Preparing Children for the Birth of a Sibling

The relationship between your children is very important. Preparing your child or children ahead of time for the birth of their new sister or brother will help them adjust when the baby is born. Below are some practical suggestions.

Prepare the older child for the new baby.

• Tell your child about his or her “babyhood” — how he or she was born and fed, how you rocked him/her and shared many hugs and kisses.
• Show your child photos when he/she was being fed, held and bathed as a baby.
• Let your child go with you to your prenatal visits. Have your child listen to the fetal heartbeat and feel the baby kick within your uterus
• Give your child a new doll so he or she can practice caring for a “baby” too.
• Make arrangements for your child’s care while you are in hospital. Discuss these arrangements with your child well before the baby’s due date. Let them know who will be caring for them while you are in the hospital
• Register your child for a Sibling Class at the hospital where you will be delivering.
• Get a “I’m the Big Sister or I’m the Big Brother” tee shirt for the older child to wear when the baby is born.
• Prepare the baby’s bedroom or sleeping area well in advance, so your child can adjust.
• Place a photo of the older child as a baby at child’s eye level in the baby’s room or where the family spends the most time.
• Talk with your child about what the new brother or sister will be like. Use books that show pictures of babies and discuss what babies can and cannot do.
• Develop a method of long-distance contact with the older child before going to the hospital. Some ideas are: call the child by phone so he/she will get used to the sound of your voice on the phone; write notes to the child to ask him or her to do small jobs; making a recording of you reading a story to the child

Involve your child in preparations for the new baby. If the child wants to, let him or her:

• Help mother pack her suitcase for the hospital.
• Help put things out in the baby’s room. Help pick out baby’s coming home clothes

Make the baby’s homecoming a special event for the whole family

• Have a birthday cake and family birthday party to celebrate the new baby when you return home from the hospital.
• If the child wants to, let him or her help making birth announcements by drawing pictures, etc.
• Have older child pass out something special to friends announcing the baby’s birth.
• Have older child and baby exchange gifts. Older child may want to pick out a special gift for the baby

Involve your child in caring for the new baby.

• If the child wants to, let him or her:

• Fold or bring the diaper to you
• Help stock the baby’s dressing table with diapers and supplies

• Let the child sing to their new sibling or tell stories

If the older sibling is not interested in helping with these activities, provide a planned activity for him or her while caring for the baby.

If the child wants to, let him or her:

• Smile and talk to the baby
• Hold the baby with supervision
• Share some (but not all) toys with the baby — let the older child keep the toys that are very special to him or her. Toys should be safe for the baby

• Have a drawer or a place in the baby’s room for some of his or her toys

Things you can do for the older child:

• Bathe the new baby and older child at the same time if older child doesn’t object.

• Assess the needs of the older child and plan to meet those needs before caring for the new baby.

Have a learning session for your older child.

Undress your baby, talk about the different parts and functions of the body — using correct terminology. Curiosity often can be satisfied by direct observation. Show your older child how to gently touch the baby’s face, head or hands. Use the words “don’t touch” as little as possible

Allow older child to verbalize negative feelings toward the baby or mother.

• Tell your child that sometimes moms don’t feel well during pregnancy. During those times and while mom is in the hospital, dad and the older child may develop an even closer relationship. Take advantage of the developing relationship and encourage it
• Talk, hold and show affection to the sibling whenever you see signs of jealously or regressive behavior. Some children regress after a younger sibling is born. The areas that may be affected include eating, toileting, crying and sleeping. Don’t put sibling “down” because of his/her regression; rather, reassure the child and offer praise for his or her “big brother” or “big sister” actions and behavior
• Praise positive behavior, ignore negative behavior. Reward only those behaviors you want to continue
• Parents may want to use a task chart with gold stars to encourage positive behavior.
• Reassure the older child that you have enough love for them and the new baby.

Remind the older child that he or she is special too.

• There is certain space in the home that belongs to the sibling exclusively. Parents and baby should respect this space
• Reinforce your child’s role in the family, especially as the older sibling.
• Give your older child “seniority” by providing special jobs at home so he or she can contribute to the family.
• Be sure to praise the older child when he or she behaves well or does good work.
• Giving your child an allowance may also be important, depending on his or her age.
• Spend time alone with your older child throughout the day and especially at bedtime.
• Encourage the child to have a doll or stuffed animal to “take care of.”
• Purchase small gifts for the older child. When visitors bring a gift for the baby, give previously purchased gift to older child.
• When friends come to visit the new baby, parents should include the older child in conversations or activities. For example, the older child could show the new baby to visitors.
• Provide a planned activity for your older child while caring for the baby.
• Father or both parents should have a planned activity outside of home with the older child only. There should be a routine weekly outing for the sibling (park, restaurant, or library).

Encourage independent behavior.

Some children enjoy knowing they are more capable of caring for themselves and seek ways of becoming more independent as a response to the baby.

• Teach the child independent behavior (at play, dressing or toileting), as appropriate for the child’s age.
• Parents may want to use a task chart for children when they help with jobs around the house and with tasks associated with the new baby.

When should I call my healthcare provider while I am pregnant and in my second trimester?

Please call right away if you have:

• Unusual or severe cramping or abdominal pain
• Noticeable changes such as a decrease in your baby’s movement after 28 weeks’ gestation (if you don’t count six to 10 movements in one hour or less)
• Difficulty breathing or shortness of breath that seems to be getting worse
• Signs of premature labor including:

• Regular tightening or pain in the lower abdomen or back
• Any bleeding in the second or third trimester
• Fluid leak
• Pressure in the pelvis or vagina

 

Rh factor testing in the second trimester

Rh factor is an antigen protein found on most people’s red blood cells. If you don’t have the protein, then you are Rh- (negative). You will be given an injection of Rh immune globulin (called Rhogam®) during the 28th week of your pregnancy to prevent the development of antibodies that could be harmful to your baby. You will also be given an injection of Rhogam after delivery if your baby has Rh+ blood.

If you are Rh- you may also receive this injection if you: are having an invasive procedure (such as an amniocentesis), had an abdominal trauma, had any significant bleeding during pregnancy, or if your baby needs to be turned in the uterus (due to breech presentation).

• Not all women experience the same symptoms when pregnant, and symptoms vary in severity.
• A woman will not necessarily experience the same symptoms in the same way in subsequent pregnancies as with her first pregnancy.
• Certain symptoms, like absence of menstruation and weight gain, are common to all pregnancies.
• Other possible symptoms and signs of early pregnancy include
  • mood changes,
  • increased urination,
  • low backache,
  • headaches
  • breast tenderness,
  • darkened areolas,
  • nausea, and
  • implantation bleeding.
• Symptoms of late pregnancy can include
  • heartburn
  • backache,
  • leakage of urine, and
  • breath  becoming short and breathlessness.
• Braxton-Hicks contractions are non-labor contractions of the uterus that occur in late pregnancy. Unlike true labor, these contractions do not increase in intensity and are irregular.
• Many medications are safe for pregnant women.
• Home remedies and self-care strategies can bring relief for many symptoms of pregnancy.
• Sometimes PMS symptoms, including mood changes,unusual tiredness and breast tenderness, may be mistaken for symptoms of early pregnancy.

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How soon do early pregnancy symptoms start?

Some women may experience symptoms within the first weeks of pregnancy in the beginning first three months or first trimester, while others may develop symptoms later on in the pregnancy. Symptoms of early pregnancy can also be similar to symptoms experienced prior to the periods, so a woman may not recognize the symptoms as related to pregnancy.

Are pregnancy symptoms the same for every woman?

• Doctor’s Views
• Reader’s comments
• Share your story with us

Symptoms of pregnancy can vary among different women. They may vary in quality or severity, and even the same woman may not experience the same symptoms in every pregnancy. Pregnancy symptoms may also be noticed or begin at different points in the pregnancy.

This article describes the most common symptoms of pregnancy in its early and later stages.

Stages of Pregnancy: 1st, 2nd, 3rd Trimester Images

 

16 Signs and Symptoms of Early Pregnancy

A number of symptoms begin in the early stages of Pregnancy:

1. Missed (late) menstrual period: A missed period is the hallmark symptom of pregnancy, and menstruation is absent throughout the pregnancy. Sometimes, the mild cramping and spotting experienced at the time of implantation of the fertilized egg in the uterus (see later) can be mistaken for a menstrual period. Women whose menstrual cycles are irregular may also not immediately notice the absence of a menstrual period.
2. Implantation bleeding or cramping: Mild bleeding or spotting may occur when the fertilized egg attaches to the uterine lining, anywhere from 6 to 12 days after fertilization. Mild cramping can also occur at this time.
3. Vaginal discharge: Some women may notice a thick, milky discharge from the Vagina  in early pregnancy. This occurs in the first weeks of pregnancy as the vaginal walls thicken. This discharge may occur throughout the pregnancy. If there is an unpleasant odor associated with the discharge, or if it is associated with burning and itching, this is a sign of a yeast or bacterial infection. You should contact your health-care professional if this occurs. You can also talk to Ms. Sunita for natural remedies for that.
4. Breast changes: Many women experience changes in the breasts as early as the first weeks of pregnancy. These changes can be felt as soreness, tenderness, heaviness, fullness, or a tingling sensation. The discomfort typically decreases after several weeks.
5. Darkening of the areola: The aerola, or area around the nipple, may darken in color.
6. Fatigue: While this symptom is very nonspecific and may be related to numerous factors, pregnant women often describe feelings of fatigue from the earliest weeks of pregnancy.
7. Morning sickness/nausea vomiting: This is actually a misnomer because the nausea of pregnancy can occur at any time of day. Some women never experience this symptom, while others have severe nausea. Its most typical onset is between the 2nd and 8th weeks of pregnancy. Most women experience relief from the symptoms around the 13th or 14th week, but others may have nausea persistent throughout the pregnancy.
8. Sensitivity to certain smells: Certain smells may bring on nausea or even vomiting early in pregnancy.
9. Increased urination: Some women will have more frequent urination  due to hormonal changes, starting about the 6th to 8th week. If other symptoms occur, such as burning on urination, you should see your health care professional to make sure you are not suffering from a urinary tract infection.
10. Dizziness or fainting: Perhaps related to hormonal changes affecting glucose levels or blood pressure, dizziness and feeling faint can occur in early pregnancy.
11. Constipation: Hormone levels can also cause some women to have constipation in early pregnancy.
12. Headaches: Headaches, as well, may be related to changing hormone levels and may occur throughout pregnancy.
13. Food cravings/aversions: Cravings may begin in early pregnancy and may last throughout the pregnancy. Likewise, food aversions (feeling nausea or distaste for a particular food) can also occur.
14. Back pain: Often considered more a symptom of late pregnancy, low back pain can actually begin in the early stages of pregnancy. Women can experience some degree of back pain throughout pregnancy.
15. Mood changes: Mood Swings are relatively common during the first trimester of pregnancy due to changing hormone levels. They may also be related to stress or other factors.
16. Shortness of breath: Increased oxygen demand by the body (to support a growing fetus) may leave some women feeling short of breath, although this symptom is more common in later stages of pregnancy.

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What are the changes that happen to a woman’s body during the 1st, 2nd, and 3rd trimester of her pregnancy?

Everyone expects pregnancy to bring an expanding waistline. But many women are surprised by the other body changes that pop up. Get the low-down on stretch marks, weight gain, heartburn and other “joys” of pregnancy. Find out what you can do to feel better.

Body aches
During pregnancy, you might have:

As your uterus expands, you may feel aches and pains in the back, abdomen, groin area, and thighs. Many women also have backaches and aching near the pelvic bone due the pressure of the baby’s head, increased weight, and loosening joints. Some pregnant women complain of pain that runs from the lower back, down the back of one leg, to the knee or foot. This iscalled Sciatica (SYE-AT-ick-uh). It is thought to occur when the uterus puts pressure on the sciatica Nerve.

What might help:

• Lie down.
• Rest.
• Apply heat.
• Yoga

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Call the doctor if:

The pain does not get better.

Breast changes

During pregnancy, you might have:

A woman’s breasts increase in size and fullness during pregnancy. As the due date approaches, hormone changes will cause your breasts to get even bigger to preparefor breastfeeding. Your breasts may feel full, heavy, or tender.

In the third trimester, some pregnant women begin to leak colostrum (coh-LOSS-truhm) from their breasts. Colostrum is the first milk that your breasts produce for the baby. It is a thick, yellowish fluid containing antibodies that protect newborns from infection.

What might help:

• Wear a maternity bra with good support.
• Put pads in the bra to absorb leakage.

Call the doctor if:

You feel a lump or have nipple changes or discharge (that is not colostrum) or skin changes.

Constipation

During pregnancy, you might have:

Many pregnant women complain of constipation. Signs of constipation include having hard, dry stools; fewer than three bowel movements per week; and painful bowel movements.

Higher levels of hormones due to pregnancy slow down digestion and relax muscles in the bowels leaving many women constipated. Plus, the pressure of the expanding uterus on the bowels can contribute to constipation.

What might help:

• Drink 8 to 10 glasses of water daily.
• Don’t drink caffeine.
• Eat fiber rich foods, such as fresh or dried fruit, raw vegetables, and whole-grain cereals and breads.
• Try mild physical activity

Call the doctor if:

If constipation does not go away.

Dizziness

During pregnancy, you might have:

Many pregnant women complain of dizziness and lightheadedness throughout their pregnancies. Fainting is rare but does happen even in some healthy pregnant women. There are many reasons for these symptoms. The growth of more blood vessels in early pregnancy, the pressure of the expanding uterus on blood vessels, and the body’s increased need for food all can make a pregnant woman feel lightheaded and dizzy.

What might help:

• Stand up slowly.
• Avoid standing for too long.
• Don’t skip meals.
• Lie on your left side.
• Wear loose clothing.

Call the doctor if:

You feel faint and have vaginal bleeding or abdominal pain.

Fatigue, sleep problems

During pregnancy, you might have:

During your pregnancy, you might feel tired even after you’ve had a lot of sleep. Many women find they’re exhausted in the first trimester. Don’t worry, this is normal! This is your body’s way of telling you that you need more rest. In the second trimester, tiredness is usually replaced with a feeling of well being and energy. But in the third trimester, exhaustion often sets in again. As you get larger, sleeping may become more difficult. The baby’s movements, bathroom runs, and an increase in the body’s metabolism might interrupt or disturb your sleep. Leg cramping can also interfere with a good night’s sleep.

What might help:

• Lie on your left side.
• Use pillows for support, such as behind your back, tucked between your knees, and under your tummy.
• Practice good sleep habits, such as going to bed and getting up at the same time each day and using your bed only for sleep and sex.
• Go to bed a little earlier.
• Nap if you are not able to get enough sleep at night.
• Drink needed fluids earlier in the day, so you can drink less in the hours before bed.
• Practice minimum 3 times per week yoga with regularity.

Heartburn and indigestion

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During pregnancy, you might have:

Hormones and the pressure of the growing uterus cause indigestion and heartburn. Pregnancy hormones slow down the muscles of the digestive tract. So food tends to move more slowly and digestion is sluggish. This causes many pregnant women to feel bloated.

Hormones also relax the valve that separates the foodpipe from the stomach. This allows food and acids to come back up from the stomach to the esophagus. The food and acid causes the burning feeling of heartburn. As your baby gets bigger, the uterus pushes on the stomach making heartburn more common in later pregnancy.

What might help:

• Eat several small meals instead of three large meals — eat slowly.
• Drink fluids between meals — not with meals.
• Don’t eat greasy and fried foods.
• Avoid citrus fruits or juices and spicy foods.
• Do not eat or drink within a few hours of bedtime.
• Do not lie down right after meals.

Call the doctor if:

Symptoms don’t improve after trying these suggestions. Ask your doctor about using an antacid.

Hemorrhoids during pregnancy

Hemorrhoids (HEM-roidz) are swollen and bulging veins in the rectum. They can cause itching, pain, and bleeding. Up to 50 percent of pregnant women get hemorrhoids. Hemorrhoids are common during pregnancy for many reasons. During pregnancy blood volume increases greatly, which can cause veins to enlarge. The expanding uterus also puts pressure on the veins in the rectum. Plus, constipation can worsen hemorrhoids. Hemorrhoids usually improve after delivery.

What might help:

• Drink lots of fluids.
• Eat fiber-rich foods, like whole grains, raw or cooked leafy green vegetables, and fruits.
• Try not to strain with bowel movements.
• Talk to your doctor about using products such as witch hazel to soothe hemorrhoids.

Itching

During pregnancy, you might have:

About 20 percent of pregnant women feel itchy during pregnancy. Usually women feel itchy in the abdomen. But red, itchy palms and soles of the feet are also common complaints. Pregnancy hormones and stretching skin are probably to blame for most of your discomfort. Usually the itchy feeling goes away after delivery.

What might help:

• Use gentle soaps and moisturizing creams.
• Avoid hot showers and baths.
• Avoid itchy fabrics.

Call the doctor if:

Symptoms don’t improve after a week of self-care.

Leg cramps

During pregnancy, you might have:

At different times during your pregnancy, you might have sudden muscle spasms in your legs or feet. They usually occur at night. This is due to a change in the way your body processes calcium.

What might help:

• Gently stretch muscles.
• Get mild exercise or yoga.
• For sudden cramps, flex your foot forward.
• Eat calcium-rich foods.
• Ask your doctor about magnesium supplements.

Morning sickness

Reader’s comments:

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In the first trimester hormone changes can cause nausea and vomiting. This is called “morning sickness,” although it can occur at any time of day. Morning sickness usually tapers off by the second trimester.

What might help:

• Eat several small meals instead of three large meals to keep your stomach from being empty.
• Don’t lie down after meals.
• Eat dry toast, saltines, or dry cereals before getting out of bed in the morning.
• Eat bland foods that are low in fat and easy to digest, such as cereal, rice, and bananas.
• Sip on water, weak tea, or clear soft drinks with cranberries. Or eat ice chips.
• Avoid smells that upset your stomach.

Call the doctor if:

You have flu -like symptoms, which may signal a more serious condition.

You have severe, constant nausea and/or vomiting several times every day.

Nasal problems

During pregnancy, you might have:

Nosebleeds and nasal stuffiness are common during pregnancy. They are caused by the increased amount of blood in your body and hormones acting on the tissues of your nose.

What might help:

• Blow your nose gently.
• Drink fluids and use a cool mist humidifier.
• To stop a nosebleed, squeeze your nose between your thumb and forefinger for a few minutes.
• Jalneti of Yoga

Call the doctor if:

Nosebleeds are frequent and do not stop after a few minutes.

Numb or tingling hands

During pregnancy, you might have:

Feelings of swelling, tingling, and numbness in fingers and hands, called Carpal Tunnel Syndrome can occur during pregnancy. These symptoms are due to swelling of tissues in the narrow passages in your wrists, and they should disappear after delivery.

What might help:

• Take frequent breaks to rest hands.
• Ask your doctor about fitting you for a splint to keep wrists straight.

Stretch marks, skin changes

Share your story

During pregnancy, you might have:

Stretch marks are red, pink, or brown streaks on the skin. Most often they appear on the thighs, buttocks, abdomen, and breasts. These scars  are caused by the stretching of the skin, and usually appear in the second half of pregnancy.

Some women notice other skin changes during pregnancy. For many women, the nipples become darker and browner during pregnancy. Many pregnant women also develop a dark line (called the linea nigra) on the skin that runs from the belly button down to the pubic hairline. Patches of darker skin usually over the cheeks, forehead, nose, or upper lip also are common. Patches often match on both sides of the face. These spots are called melisma or chloasma and are more common in darker-skinned women.

What might help:

• Be patient – stretch marks and other changes usually fade after delivery. Use jojpba oil, bio oil, palmers butter cocoa based on your skin dryness.

Swelling

During pregnancy, you might have:

Many women develop mild swelling in the face, hands, or ankles at some point in their pregnancies. As the due date approaches, swelling often becomes more noticeable.

What might help:

• Drink eight to 10 glasses of fluids daily.
• Don’t drink caffeine or eat salty foods.
• Rest and elevate your feet.
• Ask your doctor about support hose.

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Call the doctor if:

Your hands or feet swell suddenly or you rapidly gain weight – it may be preeclampsia.

Urinary frequency and leaking

During pregnancy, you might have:

Temporary bladder control problems are common in pregnancy. Your unborn baby pushes down on the bladder, urethra, and pelvic floor muscles. This pressure can lead to more frequent need to urinate, as well as leaking of urine when sneezing, coughing or laughing.

What might help:

• Take frequent bathroom breaks.
• Drink plenty of fluids to avoid dehydration.
• Do Kegel exercises to tone pelvic muscles.

Varicose Veins

During pregnancy, you might have:

During pregnancy blood volume increases greatly. This can cause veins to enlarge. Plus, pressure on the large veins behind the uterus causes the blood to slow in its return to the heart. For these reasons, varicose veins in the legs and anus (hemorrhoids) are more common in pregnancy.

Vericose Veins look like swollen veins raised above the surface of the skin. They can be twisted or bulging and are dark purple or blue in color. They are found most often on the backs of the calves or on the inside of the leg.

What might help:

• Sit with your legs and feet raised.
• Practise Yoga and specially Legs up the wall

What options help soothe and relieve pregnancy symptoms?

There are a number of home remedies and self-care strategies that can help relieve some of the unpleasant symptoms of pregnancy. Many medications, including some kinds of antibiotics, are also safe to take during pregnancy. Talk to your doctor about considering taking, or taking any over-the-counter, prescription medicine, or any supplements or Vitamins.

The following are some self-care measures can help alleviate some of the symptoms that may be troubling:

• Proper nutrition and Yoga with the right teacher can help lessen symptoms by keeping weight gain under control and strengthening and toning your abdominal muscles. After the first trimester, avoid exercises that involve lying on the back for a prolonged time.
• A pregnancy girdle or sling can help support your abdomen.
• Wear comfortable shoes that are not too tight, particularly if you have swelling of the legs.
• Be cautious when lifting your other children or heavy objects. Be sure to bend the knees when lifting and try to keep the back straight.
• You should sleep on a firm mattress. Lying on your side with a pillow between your legs may be a comfortable position that provides some relief.
• Wear a bra that provides good support if breasts are tender or sore.
• Eat lots of fiber to keep the bowels moving like psyllum husk and you should avoid constipation. This means fresh fruits and vegetables, and whole grains. Taking fiber or stool softeners may help.
• Eat small, frequent meals to combat nausea, and avoid foods that trigger nausea. Avoid fatty foods and drink plenty of fluids. Small, frequent meals can also help prevent heartburn.

Pregnancy symptoms vs. PMS (premenstrual syndrome)

Many of the symptoms of early pregnancy, like breast tenderness, fatigue, mood swings, mild cramping, pain in your back, and others, are also symptoms that women may experience (PMS) or Pre Menstrual syndrome in the days prior to their menstrual period. Until the menstrual period begins or a pregnancy test is positive, there is no way to tell whether these symptoms are related to Pre menstrual symptoms or pregnancy.

Ectopic pregnancy facts

• An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus.
• The Fallopian tubes are the most common locations for an ectopic pregnancy.
• The characteristic three symptoms of ectopic pregnancy are
  • absence of menstrual periods (amenorrhea), and
  • pain in the abdomen
  • Vaginal Bleeding

• However, only about 50% of women have all three of these symptoms.
• Risk factors for ectopic pregnancy include previous ectopic pregnancies and conditions (surgery, infection) that disrupt the normal anatomy of the Fallopian tubes.
• The major health risk of an ectopic pregnancy is rupture, leading to internal bleeding.
• Ectopic pregnancy occurs in 1%-2% of all pregnancies.
• Diagnosis of ectopic pregnancy is usually established by blood hormone tests and pelvic ultrasound.
• Treatment options for ectopic pregnancy include both surgery and medication.

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Bleeding During the First Trimester of Pregnancy

Causes of bleeding during the first trimester of pregnancy

Examples of causes of bleeding during the first trimester of pregnancy are

• ectopic pregnancy,
• cervical polyps, or
• pelvic or urinary tract infection (UTI).

Bleeding during pregnancy definition and facts

Vaginal Bleeding or spotting during the first trimester of pregnancy is relatively common.

• Some amount of light bleeding or spotting during pregnancy occurs in about 20% of pregnancies, and most of these women go on to have a healthy pregnancy.
• In some cases, particularly when there is heavy bleeding and cramping (similar to menstrual bleeding and cramping), bleeding during pregnancy is the sign of a serious problem.
• Implantation bleeding is bleeding that occurs when the fertilized egg implants in the lining of the uterus. This happens around the time of the expected menstrual period.
• Implantation bleeding may occur before a woman realizes she is pregnant.
• Serious causes of vaginal bleeding in the first trimester include
  • miscarriage,
  • threatened miscarriage, and
  • ectopic pregnancy.

What are risk factors for ectopic pregnancy?

1. Age: Ectopic pregnancy can occur in any woman, of any age, who is ovulating and is sexually active with a male partner. The highest likelihood ectopic pregnancy occurs in women aged 35-44 years.
2. History: The greatest risk factor for an ectopic pregnancy is a prior history of an ectopic pregnancy.
3. Fallopian tube abnormalities: Any disruption of the normal architecture of the Fallopian tubes can be a risk factor for a tubal pregnancy or ectopic pregnancy in other locations.
4. Previous gynecological surgeries: Previous surgery on the Fallopian tubes such as tubal sterilization or reconstructive, procedures can lead to scarring and disruption of the normal anatomy of the tubes and increases the risk of an ectopic pregnancy.
5. Infections: Infection in the pelvis (Pelvic Inflammatory Diseases) is another risk factor for ectopic pregnancy. Pelvic infections are usually caused by sexually-transmitted organism, such as Chalmydia or N. gonorrhoeae, the bacteria that cause gonorrhea. However, non-sexually transmitted bacteria can also cause pelvic infection and increase the risk of an ectopic pregnancy. Infection causes an ectopic pregnancy by damaging or obstructing the Fallopian tubes. Normally, the inner lining of the Fallopian tubes is coated with small hair-like projections called cilia. These cilia are important to transport the egg smoothly from the ovary through the Fallopian tube and into the uterus. If these cilia are damaged by infection, egg transport becomes disrupted. The fertilized egg can settle in the Fallopian tube without reaching the uterus, thus becoming an ectopic pregnancy. Likewise, infection-related scarring and partial blockage of the Fallopian tubes can also prevent the egg from reaching the uterus.
6. Multiple sex partners: Because having multiple sexual partners increases a woman’s risk of pelvic infections, multiple sexual partners also are associated with an increased risk of ectopic pregnancy.
7. Gynecological conditions: Like pelvic infections, conditions such as endometriosis, fibroids, tumors, or pelvic scar tissue (pelvic adhesions), can narrow the Fallopian tubes and disrupt egg transportation, thereby increasing the chances of an ectopic pregnancy.
8.  Use of IUD: Approximately half of pregnancies in women using intrauterine devices (IUDs) will be located outside of the uterus. However, the total number of women becoming pregnant while using IUDs is extremely low. Therefore, the overall number of ectopic pregnancies related to IUDs is very low.
9. Smoking Cigarettes: Smoking whether sheesah or Cigarette or a Pipe or being a passive smoker around the time of conception has also been associated with an increased risk of ectopic pregnancy. This risk was observed to be dose-dependent, which means that the risk is dependent upon the individual woman’s habits and increases with the number of cigarettes smoked.
10. Infertility: A history of infertility for two or more years also is associated with an increased risk of ectopic pregnancy.
    Other causes: Infection, congenital abnormalities, or tumors of the Fallopian tubes can increase a woman’s risk of having an ectopic pregnancy.

Is there a test to diagnose ectopic pregnancy?

The first step in the diagnosis is an interview and examination by the doctor. The usual second step is to obtain a qualitative (positive or negative for pregnancy) or quantitative (measures hormone levels pregnancy test. Occasionally, the doctor may feel a tender mass during the pelvic examination. If an ectopic pregnancy is suspected, the combination of blood hormone pregnancy tests and pelvic ultrasound can usually help to establish the diagnosis. Transvaginal ultrasound is the most useful test to visualize an ectopic pregnancy. In this test, an ultrasound probe is inserted into the vagina, and pelvic images are visible on a monitor. Transvaginal ultrasound can reveal the gestational sac in either a normal (intrauterine) pregnancy or an ectopic pregnancy, but often the findings are not conclusive. Rather than a gestational sac containing a visible embryo, the examination may simply reveal a mass in the area of the Fallopian tubes or elsewhere that is suggestive of, but not conclusive for, an ectopic pregnancy. The ultrasound can also demonstrate the absence of pregnancy within the uterus.

Pregnancy tests are designed to detect specific hormones; the beta subunit of human chorionic gonadotrophin (beta HCG) blood levels are also used in the diagnosis of ectopic pregnancy. Beta HCG levels normally rise during pregnancy. An abnormal pattern in the rise of this hormone can be a clue to the presence of an ectopic pregnancy. In rare cases, laproscopy may be needed to confirm a diagnosis of ectopic pregnancy. During laparoscopy, viewing instruments are inserted through small incisions in the abdominal wall to visualize the structures in the abdomen and pelvis, thereby revealing the site of the ectopic pregnancy.

Is an ectopic pregnancy dangerous?

Some women spontaneously absorb the fetus from the ectopic pregnancy, and have no apparent side effects. In these instances, the woman can be observed without treatment. However, the true incidence of spontaneous resolution of ectopic pregnancies is unknown. It is not possible to predict which women will spontaneously resolve their ectopic pregnancies.

The most feared complication of an ectopic pregnancy is rupture, leading to internal bleeding, pelvic and Abdominal Pain, shock, and even death. Therefore, bleeding in an ectopic pregnancy may require immediate surgical attention. Bleeding results from the rupture of the Fallopian tube or from blood leaking from the end of the tube as the growing placenta erodes into the veins and arteries located inside the tubal wall. Blood coming from the tube can be very irritating to other tissues and organs in the pelvis and abdomen, and result in significant pain. The pelvic blood can lead to scar tissue formation that can result in problems with becoming pregnant in the future. The scar tissue can also increase the risk of future ectopic pregnancies.

Which specialties of doctors treat ectopic pregnancy?

Obstetrician-gynecologists (OB-GYNs) are the specialists who typically treat ectopic pregnancies. However, emergency medicine specialists and surgeons treat ruptured ectopic pregnancies. If you think you may have a ruptured ectopic pregnancy go to your nearest emergency room right away.

What treatment options are available for ectopic pregnancy?

Treatment options for ectopic pregnancy include observation, laparoscopy, laparotomy, and medication. Selection of these options is individualized. Some ectopic pregnancies will resolve on their own without the need for any intervention, while others will need urgent surgery due to life-threatening bleeding. However, because of the risk of rupture and potential dire consequences, most women with a diagnosed ectopic pregnancy are treated with medications or surgery.

For those who require intervention, the most common treatment is surgery.

Two surgical options are available; laparotomy and laparoscopy. Laparotomy is an open procedure whereby a transverse (bikini line) incision is made across the lower abdomen. Laparoscopy involves inserting viewing instruments into the pelvis through tiny incisions in the skin. For many surgeons and patients, laparoscopy is preferred over laparotomy because of the tiny incisions used and the speedy recovery afterwards. Under optimal conditions, a small incision can be made in the Fallopian tube and the ectopic pregnancy removed, leaving the Fallopian tube intact. However, certain conditions make laparoscopy less effective or unavailable as an alternative. These include massive pelvic scar tissue and excessive blood in the abdomen or pelvis. In some instances, the location or extent of damage may require removal of a portion of the Fallopian tube, the entire tube, the ovary, and even the uterus.

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What medications treat ectopic pregnancy?

Medical therapy can also be successful in treating certain groups of women who have an ectopic pregnancy. Medical treatment method involves the use of an anti-cancer drug called methotrexate ( Rheumatrex, Trexall).  This drug acts by killing the growing cells of the placenta, thereby inducing miscarriage of the ectopic pregnancy. Some patients may not respond to methotrexate, and will require surgical treatment. Methotrexate is gaining popularity because of its high success rate and low rate of side effects.

There are certain factors, including the size of the mass associated with the ectopic pregnancy and the blood beta HCG concentrations that help doctors decide which women are candidates for medical rather than surgical treatment. The optimal candidates for methotrexate treatment are women with a beta-subunit (HCG) concentration less than or equal to 5000 mIU/mL. In a properly selected patient population, methotrexate therapy is about 90% effective in treating ectopic pregnancy. There is no evidence that the use of this drug causes any adverse effects in subsequent pregnancies. Additional tests (HCG) are usually ordered to confirm that methotrexate treatment is effective.

Can an ectopic pregnancy go full term?

Although there have been a few reported cases of women giving birth by cesarean section to live infants that were located outside the uterus, this is extremely rare. The chance of carrying an ectopic pregnancy to full term is so remote, and the risk to the woman so great, that it can never be recommended. It would be ideal if an ectopic pregnancy in the Fallopian tube could be saved by surgery to relocate it into the uterus. This concept has yet to become accepted as a successful procedure.

Overall, there have been great advances in the early diagnosis and treatment of ectopic pregnancy, and the mortality from this condition has decreased dramatically.

Is bleeding during pregnancy normal?

Vaginal bleeding during the first three months of pregnancy is relatively common and usually is a cause of concern for the mother. Women wonder how much bleeding during early pregnancy is normal. While early bleeding may indicate the presence of a serious problem, this is frequently not the case. In fact, approximately 20% of pregnant women experience light bleeding or spotting during the first trimester of pregnancy. Most women go on to have uncomplicated pregnancies and ultimately deliver a healthy baby.

Spotting: Spotting usually refers to a few drops of blood that would not cover a pad or panty liner. Bleeding refers to blood flow that is heavy enough to require wearing a pad. If bleeding occurs during the first trimester, a panty liner or pad should be worn so that you are able to get an idea of the amount of bleeding that is occurring and can tell the health-care professional. However, you should not use a tampon in the vagina during pregnancy or douche.

Changes in the cervix: The normal hormone production during pregnancy can cause changes to the cervix, rendering it softer and more prone to bleeding. Also, a cervical polyp (a benign overgrowth of tissue) may form, and this may bleed more easily during pregnancy. In both cases, spotting or light bleeding may be provoked following sexual intercourse or a pelvic examination.

Infection: A vaginal infection may cause spontaneous vaginal bleeding. The bleeding may be accompanied by an abnormal vaginal discharge.

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What is implantation bleeding during the first trimester? What are the symptoms and signs?

A common benign cause of bleeding may occur even before a woman realizes that she is pregnant. Many women bleed when the fertilized egg attaches to the lining of the uterus. This is called implantation bleeding. It frequently occurs when the next menstrual period is expected. Signs of implantation bleeding are light bleeding or spotting around the time of the expected menstrual period. This does not happen in every pregnancy.

What are other common causes of bleeding during the first trimester of pregnancy?

• Changes in the cervix: The normal hormone production during pregnancy can cause changes to the cervix, rendering it softer and more prone to bleeding. In addition, a cervical polyp (a benign overgrowth of tissue) may form, and this may bleed more easily during pregnancy. In both cases, spotting or light bleeding may be provoked following sexual intercourse or a pelvic examination.
• Infection: A vaginal infection may cause spontaneous vaginal bleeding. The bleeding may be accompanied by an abnormal vaginal discharge.

What are serious causes heaving bleeding during the first trimester of pregnancy?

Vaginal bleeding during early pregnancy may sometimes indicate a serious problem. Serious causes of bleeding in pregnancy include:

Miscarriage

• Bleeding, abdominal pain, and back pain are common signs of miscarriage.
• An exam shows that the cervix is open.
• Tissue may be extruded through the cervix and vagina.
• A miscarriage occurs in an estimated 15% to 20% of pregnancies, usually during the first 12 weeks of gestation.
• A genetic defect confined to the specific embryo in question represents the most common cause of miscarriage.
• Few circumstances exist wherein a miscarriage in progress can be prevented.

Molar pregnancy

• Molar pregnancy, also known as gestational trophoblastic disease or hydatidiform mole, is an abnormality of fertilization that results in the growth of abnormal tissue within the uterus.
• Molar pregnancy is not a typical pregnancy, but the growth within the uterus leads to the typical symptoms of early pregnancy.
• In a complete hydatiform mole, there is only abnormal tissue in the uterus (and no fetus).
• In a so-called partial mole, there is abnormal tissue growth along with the presence of a fetus with severe birth defects.
• The fetus is typically consumed by the abnormal growth of tissue in the uterus, and a molar pregnancy cannot result in a normal fetus or delivery.
• Vaginal spotting or bleeding can be a symptom of molar pregnancy.
• A sonogram or ultrasound is used to diagnose a molar pregnancy.

Ectopic pregnancy

• Mild vaginal bleeding and increasing abdominal pain  may indicate the presence of an ectopic pregnancy.
• An ectopic pregnancy occurs in approximately 1 out of 60 pregnancies.
• An ectopic pregnancy occurs when the fertilized egg implants outside of the uterus, where the blood supply is inadequate to sustain the growth of a normal pregnancy.
• In the majority of cases of ectopic pregnancy, the embryo is located within one of the Fallopian tubes; this sometimes is referred to as a tubal pregnancy. As the pregnancy grows and the tube distends, Abdominal Pain becomes increasingly severe.
• Sometimes these pregnancies can actually rupture the Fallopian tube, leading to significant blood loss.

Threatened miscarriage

• If a woman is bleeding during the first trimester of pregnancy, the possibility of a miscarriage must be ruled out.
• Symptoms of a threatened miscarriage are bleeding and mild cramping, but the cervix stays closed and the fetus is still viable.
• In many women, the bleeding stops and the pregnancy continues. For others, the bleeding continues, and they eventually have a miscarriage (i.e. spontaneous pregnancy loss).
• Despite many articles in the lay press, there is no evidence that restriction of physical activity will aid in preventing a pregnancy loss.

Subchorionic hemorrhage

• In this condition blood collects between the gestational sac and the wall of the uterus.
• At times, the intrauterine clot can be seen on ultrasound examination.
• The body frequently reabsorbs these blood Clots; however, occasionally there may be passage of old dark blood or even small clots from the vagina.
• What causes bleeding during the second and third trimesters of pregnancy?
• Bleeding or spotting later in pregnancy can be due to a number of causes. Sometimes, having sex or even having an internal (pelvic) examination by your OB/GYN or Midwife can cause light bleeding. Problems with the cervix, including cervical insufficiency (when the cervix opens too early in pregnancy) or infection of the cervix, can lead to bleeding. More serious causes of bleeding in later pregnancy include , Placenta Previa , preterm labor, uterine rupture, or placental abruption.
• When to call your doctor if you have bleeding during pregnancy
• Any time you notice bleeding during any stage of pregnancy, it is appropriate to call your doctor. It is particularly important to seek medical attention if the bleeding is heavy (like a menstrual period) or accompanied by painor cramping.
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What is an ultrasound?

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While the patient’s history and physical examination are the initial steps of making a medical diagnosis, the ability to peer inside the body can be a powerful tool. Ultrasound is an imaging technique that provides that ability to medical practitioners.

Ultrasound produces sound waves that are beamed into the body causing return echoes that are recorded to “visualize” structures beneath the skin. The ability to measure different echoes reflected from a variety of tissues allows a shadow picture to be constructed. The technology is especially accurate at seeing the interface between solid and fluid filled spaces. These are actually the same principles that allow SONAR on boats to see the bottom of the ocean.

What is ultrasonography?

Ultrasonography is a form of body imaging using sound waves to facilitate makeing a medical diagnosis. A skilled ultrasound technician is able to see inside the body using ultrasonography to answer questions that may be asked by the medical practitioner caring for the patient. Usually, a radiologist will oversee the ultrasound test and report on the results, but other types of physicians may also use ultrasound as a diagnostic tool. For example, obstetricians use ultrasound to assess the fetus during pregnancy. Surgeons and emergency physicians use ultrasound at the bedside to assess abdominal pain or other concerns.

A transducer, or probe, is used to project and receive the sound waves and their echoes. A gel is wiped onto the patient’s skin so that the sound waves are not distorted as they cross through the skin. Using their understanding of human anatomy and the machine, the technician can evaluate specific structures and try to answer the question asked by the patient’s physician. This may take a fair amount of time and require the probe to be repositioned and pointed in different directions. As well, the technician may need to vary the amount of pressure used to push the probe into the skin. The goal will be to “paint” a shadow picture of the inner organ that the health care practitioner has asked to be visualized.

The physics of sound can place limits on the test. The quality of the picture depends on many factors.

• Sound waves cannot penetrate deeply, and an obese patient may be imaged poorly.
• Ultrasound does poorly when gas is present between the probe and the target organ. Should the intestine be distended with bowel gas, organs behind it may not be easily seen. Similarly, ultrasound works poorly in the chest, where the lungs are filled with air.
• Ultrasound does not penetrate bone easily.
• The accuracy of the test is very much operator dependent. This means that the key to a good test is the ultrasound technician.

Ultrasound can be enhanced by using Doppler technology which can measure whether an object is moving towards or away from the probe. This can allow the technician to measure blood flow in organs such as the heart or liver, or within specific blood vessels.

For what purposes are ultrasounds used?

Ultrasound is not limited to diagnosis, but can also be used in screening for disease and to aid in treatment of diseases or conditions.

Diagnostic uses for ultrasound

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Obstetrics

Ultrasound is routinely used for assessing the progression of a pregnancy. Pelvic ultrasounds can be obtained trans-abdominally where the probe is placed on the abdominal wall, or trans-vaginally, where the probe is placed in the vagina. For example ultrasound in obstetrics/gynecology is used to diagnose growths or tumors of the ovary, uterus, or, Fallopian tubes.

Cardiology

Echocardiography

Echocardiography (echo=sound + cardio=heart + graphy=study) evaluates the heart, the heart valve’s motion, and blood flow through them. It also evaluates the heart wall motion and the amount of blood the heart pumps with each stroke.

Echocardiography can be performed in two ways:

• trans-thoracic: the probe is place on the chest wall to obtain images, and
• trans-esophageal: where the probe is placed through the mouth into the esophagus.

Anatomically, the esophagus sits near the heart and allows clearer images. However, this approach is a little more invasive.

Different groups of illnesses can be assessed by echocardiography:

• Valves in the heart keep blood flowing in one direction when the heart pumps. For example, when the heart beats, blood is pumped from the left ventricle through the aortic valve into the aorta and the rest of the body. The aortic valve prevents blood from back-flowing into the heart as it fills for the next beat. Echocardiography can determine if the valve is narrow or leaking (regurgitating, insufficient). By following how the patient fares clinically, repeated echocardiograms can help determine whether valve replacement or repair is warranted. The same principles apply to the mitral valve which keeps blood flowing from the left atrium to the left ventricle.
• The heart muscle pumps blood to the body. If the heart weakens, the amount of blood it pumps with each beat can decrease, leading to congestive heart failure. The echocardiogram can measure the efficiency of the heart beat and how much blood it pumps; which assists in determining whether medications are needed. It also is used to monitor how well medications are working.
• Echocardiography can visualize the heart chambers to detect blood clots in conditions such as atrial fibrillation (an irregular heart rhythm). In other situations, the test can help diagnose endocarditis (an infection of the heart valves) by visualizing “vegetations” (an infected mass) on the valves themselves.
• Echocardiography also can detect abnormal fluid collections (pericardial effusions) in the pericardium.
• Echocardiograms are used to diagnose and monitor pulmonary artery hypertension.

Blood vessels

Ultrasound can detect blood clots in veins (superficial or deep venous thrombosis) or artery blockage (stenosis) and dilatation (aneurysms). Some examples of ultrasound testing include:

• Carotid ultrasound is performed in patients with transient ischemic attacks (TIAs) or strokes to determine whether the major arteries in the neck are blocked causing the decreased blood supply to the brain.
• The aorta is the large blood vessel leaving the heart that supplies blood to the rest of the body. The walls of the aorta are under significant pressure from the force of the heartbeat and over time, may weaken and widen. This is called an aneurysm, and it can be detected in the abdomen by ultrasound (abdominal aortic aneurysm ). For those patients with small aneurysm, observation may be recommended and the aneurysms size followed over time by repeated tests.
• Veins can also be evaluated by ultrasound and it is a common test to assess whether swelling in a leg is due to a blood clot, deep vein thrombosis ( DVT) or another cause.

Abdominal structures

Aside from its use in obstetrics, ultrasound can evaluate most of the solid structures in the abdominal cavity. This includes the liver, gallbladder, pancreas, kidneys, bladder, prostate, testicles, uterus, and ovaries.

• Ultrasound is the preferred technique to test for gallstones or an infected gallbladder. The ultrasound can reveal the stones as well as signs of infection, including thickening of the gallbladder wall and fluid surrounding the gallbladder. The ultrasound may find blockage in the bile ducts.
• For those patients where the radiation of a CT Scan ( computerized Tomography) is a potential risk (pregnant patients or children), ultrasound may be used to look for diseases like appendicitis or Kidney Stones.
• Ultrasound is the test of choice to diagnose testicular torsion.
• Pelvic ultrasound is used in gynecology to help assess non-pregnancy related issues like lower abdominal pain, ovarian cysts, uterine fibroids, uterine growths and endometriosis.

The neck

The Thyroid gland can be imaged using ultrasound looking for nodules, growths, or tumors.

Knee joint

Ultrasound can be used to detect bulging of fluid from a swollen Knee Joint into the back of the knee, called a Baker’s cyst.

Screening uses for ultrasound

Ultrasound may be used to screen for blood vessel diseases. By measuring blood flow and blockage in the carotid arteries, the test can predict potential risk for future Stroke. Similarly, by measuring the diameter of the aorta in the abdomen, ultrasound can screen for aneurysm (abnormal dilatation) and the risk of rupture. These tests may be indicated for an individual patient or they may be offered as a community wide health screening assessment.

Therapeutic uses for ultrasound

Ultrasound may be used to help physicians guide needles into the body.

In situations where an intravenous line is required but it is difficult to find a vein, ultrasound guidance may be used to identify larger veins in the neck, chest wall, or groin.

Ultrasound may be used to guide a needle into a cavity that needs to be drained (for example, an abscess) or a mass that needs to be biopsied, where a small bit of tissue is removed for analysis.

What are the risks of ultrasound?

There are no known risks to ultrasound, and as technology has improved, the machines have become smaller, portable and available for use at the patient’s bedside.

How do patients prepare for an ultrasound?

Preparation for ultrasound is minimal. Generally, if internal organs such as the gallbladder are to be examined, patients are requested to avoid eating and drinking with the exception of water for six to eight hours prior to the examination. This is because food causes gallbladder contraction, minimizing the size, which would be visible during the ultrasound.

In preparation for examination of the baby and womb during pregnancy, sometimes it is recommended that mothers drink at least four to six glasses of water approximately one to two hours prior to the examination for the purpose of filling the bladder. This helps improve the images captured during the exam.

How are the results of ultrasound interpreted and communicated to the physician?

The ultrasound is generally performed by a technician. The technician will notice preliminary structures and may point out several of these structures during the examination. The official reading of the ultrasound is done by a radiologist, a physician who is an expert at interpreting ultrasound images. The radiologist records the interpretation and transmits it to the practitioner requesting the test. Occasionally, during the ultrasound test the radiologist will ask questions of the patient and/or perform an examination in order to further define the purpose for which the test is ordered, or to clarify preliminary findings.

Plain x-rays might be ordered to further evaluate early findings.

A summary of results of all of the above is reported to the health care practitioner who requested the ultrasound. They are then discussed with the patient in the context of the patient’s overall health status.

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