The stages of pregnancy - Part 1

Monique Rainford, HER HEALTH

SHE COMES into my office and announces that she had a positive pregnancy test. Actually, she did more than one. "Do I need to repeat the test?" she asks. I tell her that it is not necessary and suggest that she get an early ultrasound to confirm that the pregnancy is in the right place and her due date.

I counsel her on her nutrition and advise her against eating shark, swordfish, tile fish, and king mackerel since these have high levels of mercury which could be harmful to the developing baby. Fortunately, those fish, are not too common here. I advised her to avoid unpasteurised cheese and deli meats unless they were heated thoroughly.

She is older than 35, and so we speak about screening tests. because of her age, her baby does have increased risk of Down's syndrome and other abnormalities. She can do a blood test in the first or second trimester of pregnancy to evaluate her risks. She can also do an amniocentesis, which involves taking some of the fluid surrounding her baby and testing it for the baby's chromosomes and risk for neural tube defects. She will discuss it with her husband. She is not certain whether or not she wants the tests done.

Nausea and poor appetite

She returns to me a few weeks later. She is often nauseous and her appetite is poor. Fortunately, she is not losing any weight. I suggest that she take some Gravol to alleviate her symptoms. She is worried about taking any medication in pregnancy. I assure her that the medication is safe.

She had passed through the first trimester. She is still experiencing some nausea but it has improved and so has her appetite.

Unfortunately, she is experiencing heartburn and some constipation. I suggest certain medications for the heartburn and an increase in fluids and fibre to help with the constipation. She has opted not to do the screening tests. She will hope for the best. I recommend that she does an ultrasound between 18 and 20 weeks to check that the baby appears normal. She also wants to know if she is having a boy or a girl.

Too much weight gain?

She returns in a few more weeks and she wonders if her belly is growing enough or if she is gaining enough weight. I remind her that since her weight was normal before her pregnancy, she only needs to gain between 52.5 and 73.5 kg (25 and 35 pounds). I look at her weight gain and measure the growth of the top of the womb.

I listen to the baby's heart-rate. She is on track. I tell her that she should avoid sleeping on her back and try to sleep on her left side. This is to avoid her growing womb putting pressure on the main vein in the body that returns the blood to her heart. She admits that she is having difficulty finding a comfortable sleeping position.

Dr Monique Rainford is a consultant obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.