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Dr Tatenda Simango

I hope I find you well and in good spirits. Covid-19 cases are now on a downward trajectory and we hope the opening of schools will not push an increase of cases that will take us backwards.

I have noted the increase in scans being done in the past two weeks at our centre and thought we need to discuss on the importance of medical care of the expecting mother (antenatal care/ANC). The nine-month duration of pregnancy is divided into three-month stages termed trimesters.

Pregnancy can cause a lot of anxiety especially with first time mothers. The mother’s body undergoes many changes during pregnancy that ensure the growing baby’s (foetal) breathing, nutrition and excretion, as well as protecting the mother at birth.

The aims of antenatal care are to promote the wellbeing of the mother and her developing baby, to monitor the pregnancy, and identify any problems so that appropriate action can be taken. Antenatal care includes providing information, advice, and reassurance about pregnancy, childbirth, and motherhood as well as monitoring, screening, and treating problems where necessary.

The comprehensive 2008 NICE guideline for routine antenatal care for healthy pregnant women recommends 10 scheduled appointments for first pregnancy women and seven for women with an uncomplicated pregnancy history.

The first appointment in pregnancy should be early (before 12 weeks’ gestation) so that women can be provided with information to allow them to make decisions about a range of issues, including the pattern of care they wish to receive, choices about antenatal screening, and early discussions about planned place of birth. Women can also be provided with information on their lifestyle which helps to optimise their health during pregnancy, e.g. diet, exercise, smoking, drugs, alcohol and working patterns.

The majority of women can be reassured it is safe to continue working during pregnancy. Exercise started or maintained in pregnancy has not been associated with any adverse outcome. Women should avoid potentially dangerous activities, especially those that can result in stomach injury. Physically demanding work and prolonged standing is associated with poor pregnancy outcomes. Pregnant women and their employers should assess the significance of this risk and adjust occupational exposure accordingly during the pregnancy.

Sexual intercourse in pregnancy is not known to be associated with any adverse outcomes.

Common problems in pregnancy include nausea and vomiting particularly in the first trimester. It’s more common in early pregnancy and can be worse in multiple pregnancy (like twins). The mother usually needs reassurance, however, ginger can reduce severity.

Heartburn — a burning sensation or discomfort felt behind the sternum or throat or both can occur. Maintaining an upright posture especially after meals, eating small frequent meals, avoiding irritants such as caffeine or other trigger foods can assist. Safe first line treatments include Gaviscon® or magnesium trisilicate. elayed stomach emptying predisposes to indigestion, and constipation.

Constipation in pregnancy is made worse with iron supplements. High fibre content in the diet is frequently effective, treatment with laxatives is best avoided.

There is an increased demand for iron and folate by the growing baby, which means the mother may need to supplement using tablets. This reduces the risk of birth defects in the growing foetus. Women should be advised that few complementary therapies have been shown to be safe and beneficial in pregnancy and some Chinese herbal therapies are toxic. Usually a balanced diet will suffice.

Women should also be told that excess alcohol in pregnancy has an adverse effect on the foetus, including low birth weight, learning difficulties or, with heavy and prolonged drinking, foetal alcohol syndrome.

Current advice limits alcohol intake to no more than one to two units per week. One unit of alcohol is a single measure of spirit, one small glass of wine, half a pint of regular strength beer, lager or cider.

Smoking is associated with adverse pregnancy and prenatal outcomes. Women should be encouraged to stop or reduce smoking. Women should be discouraged from using cannabis or other illicit drugs.

As the womb grows, it starts to compress blood vessels in the pelvis which may cause dizziness and at times may lead to fainting/collapsing and nausea. Pregnant women especially from the second trimester going forward are encouraged to lie on their left side so as to reduce pressure on the pelvic blood vessels.

Backache and pelvic bone pain in pregnancy is very common, it is associated with the weight of the baby on the back. Pain in the pelvic area, including pelvic pain radiating to the upper thighs and perineum and classically tenderness on palpation of the pubic bones. Symptoms are exacerbated with movement, e.g. walking, climbing stairs, etc. and are relieved with rest. Symptoms are most common in the second and third trimesters. No good effective treatments exist. Simple pain relief, pelvic support, and reassurance appear to offer some relief.

Increase in vaginal discharge is a common normal change in pregnancy. Further investigation is warranted if it is associated with a strong smell, soreness, itching or pass on passing urine.

Urinary stasis (‘holding urine’) predisposes to urinary tract infections, these usually present with pain on passing urine, increased frequency of passing urine and pelvic pain. Increased water intake will help reduce the risk of urinary tract infections.

Close follow up and monitoring is required for mothers with pre-existing medical conditions like:

Hypertension, diabetes, epilepsy or psychiatric disorder, cancer, HIV.

Age under 18 years or over 40 years. BMI <18 or >35,

Previous operations like Caesarean Section or uterine surgery, e.g. myomectomy,

Three or more miscarriages under 12 weeks,

Previous preterm birth or mid-trimester loss,

Previous baby with birth defects,

Previous baby <2.5kg or >4kg at term.

Initial ultrasound scan is recommended in the first trimester as it helps determine if the pregnancy is sitting well in the uterus and for estimation of accurate expected dates. Mothers should be offered ultrasound screening for any structural abnormalities at about 20 weeks. If there are no other complications, there will be no need for further scan at a later stage.

Pregnancy has not been seen to have worse outcomes in light of Covid-19.

Till next week, stay safe.