Morning sickness is quite prevalent in the first trimester of pregnancy. It often starts during the 6th week of pregnancy, peaks around week 9, and disappears in 95% of women by the 12th week, but can last up to 16–18 weeks. This rarely extends to the time of  delivery.

Morning sickness can occur any time of day. It has been found that the Pregnancy hormones cause this unpleasant sense of loss of appetite, nausea and vomiting that can sometimes be severe.

It is then called Hyperemesis gravidarum and is a serious disorder. Hyperemesis is associated with frequent vomiting, weight loss, inability to eat or drink, and may need hospitalization for IV fluids and medication.

Women with a history of gastrointestinal issues (ie, reflux, ulcers), those who are pregnant with twins, triplets, or other multiples and molar pregnancies are more likely to develop nausea and vomiting during pregnancy.

Diet and lifestyle changes treat mild to moderate vomiting without dehydration:

• Dietary intervention, we recommend multiple modest protein and carbohydrate-rich diets.
• Your taste buds don’t enjoy your usual flavors but will tolerate modest changes. Ginger—powdered ginger or ginger tea—may aid some women with nausea and vomiting.
• Focus on something else while eating.
• Eat before you’re hungry to avoid gastritis.
• You may still feel nauseous after dietary changes.
• Tolerating the symptoms lets you eat and drink enough to be hydrated and not lose weight.
• Smelling fresh lemon, mint, or orange or using an oil diffuser with these aromas may also help, but you may change the fragrances often to keep your senses fresh.

Identifying and avoiding triggers (smells, tastes, sounds) is one of the best ways to reduce pregnancy-related nausea and vomiting.

• Avoiding spicy meals helps some ladies.
• Brushing your teeth or rinsing with mouthwash after eating can minimize nausea caused by residual food flavour.

Dehydration may require intravenous (iv) fluids if you can’t eat or drink. Depending on your vomiting severity, your doctor or nurse may do this at their office or in the hospital. To rest the intestines, you may not eat or drink for a while. After 24–48 hours, you can start eating and drinking again. In severe situations, steroids or antiemetics to prevent vomiting are administered.

Pregnancy-related nausea and vomiting usually resolves without consequences. Early-pregnancy vomiting reduces weight gain. Unless the woman was underweight before pregnancy, this rarely affects the baby.

Women with severe nausea and vomiting (hyperemesis gravidarum) who are hospitalized numerous times and don’t gain weight throughout pregnancy have a slight risk of having a smaller baby.

Hyperemesis gravidarum recurs in 15–20% of subsequent pregnancies.

Why are many pregnant women diabetic?

GDM is any glucose intolerance that begins during pregnancy.

the glucose intolerance may have been pre-existing or started during the current pregnancy.

GDM is a common pregnancy condition. It can harm both the mother and the child.

It has been proven that Pregnancy changes maternal glucose metabolism. Placental hormones enhance insulin resistance throughout pregnancy. Insufficient insulin release in response to high blood sugar causes GDM.

GDM screening begins at the time of “booking”. Fasting blood glucose or timed glucose levels are measured and rechecked at 24–28 weeks of gestation with a 75gm oral glucose tolerance test  (OGTT). Low-risk pregnant women follow this monitoring protocol. Patients at high risk of GDM in the present pregnancy are screened twice with the 75gm GTT, once during the booking visit and again at 24-28 weeks.

High-risk women are those with

• BMIs of 30 kg/m2.
• Previous GDM or fetal macrosomia.
• Diabetes Mellitus in the family.
• urine dipstick glucose (2+ or above on one occasion, 1+ on two or more times).

Management:

An obstetrician, endocrinologist, and dietitian manage this condition of GDM. As pregnancy progresses, certain patients may need pharmacologic therapy with pills or insulin injections to avert problems.

How does it affect the fetus and the newborn (before and after birth)?

Uncontrolled GDM can harm fetal growth in each trimester.

During the first trimester it may cause spontaneous miscarriages and significant congenital abnormalities. Usually if the diabetes is obvious in these mothers.

Uncontrolled glucose can cause fetal macrosomia (abnormally large fetal growth) and sudden intrauterine death in the second and third trimesters.

Postnatal hypoglycaemia, jaundice, and polycythemia are more likely to babies born to mothers with GDM.

GDM in the mother increases the likelihood of childhood obesity and glucose intolerance.

GDM fades in 95% of women post-delivery. But are the 20%–60% chance of getting diabetes in the future and there is an increased risk of GDM in consecutive pregnancies.

Therefore a 75 gm OGTT (2-step) should be done at least 6 weeks post-partum if glucose levels and OGTT are normal. Lifestyle modification and Annual glucose and HbA1C testing can detect worsening glycemic control and predict Type 2 DM.

All patients with a past history of GDM should consider lifestyle, diet, and exercise regimens to reduce insulin resistance and prevent or delay DM.

If the OGTT is impaired, lifestyle changes and 3–6-month blood glucose monitoring are recommended.

If gestational diabetes continues post-delivery, we start DM treatment with the endocrinologist.

Families should help children adopt an obesity-preventive culture and good habits from a young age to prevent GDM and its adverse effects that can affect the whole life of the mother and child.

MENORRHAGIA is the medical term for heavy menstrual bleeding.

The term MENORRHAGIA is used if vaginal bleeding lasts more than 7 days or, less than 7 days, but is bleeding with huge clots, needing to change pads or tampons every 1 or 2 hours, or overflowing even with extra-large sanitary pads.

When you notice you have this condition, visit a gynaecologist to find the source and get treated, because long-term disregarded heavy periods can develop to anaemia and associated complications:

1. extreme exhaustion
2. breathlessness
3. hindering daily work.

Menorrhagia’s likely causes are,

1) Hormonal imbalance—the most prevalent cause of MENORRHAGIA is oestrogen and progesterone imbalance. The menstrual period may be delayed and heavy or protracted. This trend is prevalent in the year after menarche (first periods). Due to hormonal immaturity. Polycystic ovaries, high Prolactin levels, thyroid hormone insufficiency, and obesity can also cause this!

2) Endometrial polyps: excessive growth of the uterine lining

3) Fibroids: noncancerous uterine wall growths

4) Adenomyosis: uterine tissue appears in the muscular layer.

5) Intra uterine devices for contraception. (IUD).

6) Bleeding diseases (rarely)

7) Menorrhagia can result from a miscarriage, especially if the pregnancy is unknown.

8) Postmenopausal women with uterine or cervical cancer may have excessive vaginal bleeding.

9) Rarely blood thinners for medical disorders.

Diagnosis and tests needed:

Includes your gynaecologist speaking to you to understand the problem, examining you, taking a pap smear, a basic pelvic scan, a hormonal workup including thyroid profile and a complete blood count.

Treatment:

Treat the cause of Heavy bleeding

Low hemoglobin requires iron supplementation.

If obese, hormonal imbalance treatment begins with weight loss, then Tranexmic acid is a non-hormonal treatment that reduces bleeding.

Hormone tablets, injectables, or the Mirena intrauterine device are utilized if hormones fail.

Hysteroscopic polypectomy removes endometrial polyps.

Hormones are used to treat adenomyosis.

Hormone-modulating drugs or surgery can treat uterine fibroids.

• • Gestational hypertension—high Blood Pressure that occurs after week 20 and disappears after delivery.

  After week 20, gestational hypertension can cause preeclampsia which is High BP with protein in the urine.

  Will I get gestational hypertension?

  First-time parents and women whose sisters and mothers experienced pregnancy-induced hypertension (PIH) are more likely to develop gestational hypertension.

  • Women under 20 or over 40
  • Women with high blood pressure or kidney illness before pregnancy

   

  How is my pregnancy managed if I have PIH?

  If you have mild hypertension and your baby is underdeveloped, your doctor may suggest:

  • Rest on your left side to reduce the baby’s weight on the main blood vessels of the abdomen.
  • Increase prenatal checks.
  • Reduce salt.

  Your doctor may manage severe hypertension with blood pressure medication until you can deliver safely.

  How does gestational hypertension effect my baby?

  Mother’s placenta gives infant oxygen and nutrition. In pregnant hypertension, placental blood arteries constrict, reducing oxygen and food to the baby and affecting its growth. This reduces intrauterine growth and birth weight. Not all gestational hypertensive women have this. If controlled, moderate gestational hypertension does not affect the baby.

  Preeclampsia, caused by excessive hypertension, can harm mom and baby.

  Gestational hypertension affects my health how?

  Especially if your BP is uncontrolled or severe, it can affect your

  • kidneys, leading to medical renal disease,
  • cause convulsions called eclampsia,
  • retinal haemorrhage,
  • liver dysfunction,
  • abnormal blood clotting mechanism,
  • HELLP syndrome,
  • and pulmonary oedema, which causes breathlessness.

   

  Gestational hypertension cannot be prevented. Some causes of high blood pressure can be controlled.

  • Resting helps prevent gestational hypertension.
  • Regular exercise.
  • Avoid alcohol and caffeine.

   

  If your doctor suspects gestational hypertension, they may prescribe medications.

Delaying childbearing has revealed the reproductive limits of women and men.

The infertility rates of nulliparous women increase dramatically with age, from 7%–9% at 15–34 years to 25% at 35–39 years and 30% at 40–44 years. Because older women produce ova of lower quality and their reproductive physiology declines, their risk of infertility increases. Typical causes include endometriosis, uterine leiomyomata, ovulatory dysfunction, and tubal disease. Counselling, medication, and surgery are utilized to treat infertility. The most common medical services for infertile women of reproductive age are clinical examination and reproductive counselling (29%), testing of the woman and her male companion (27%), and ovulation drugs (20%). IVF (7%), hysterectomy (3%), and ART (3%). Infertility treatments can be detrimental to both mother and infant. Ovarian hyperstimulation syndrome (OHSS), which causes ovarian enlargement and abdominal fluid accumulation, is a rare but hazardous side effect of ovulation-inducing drugs. In most cases, OHSS resolves spontaneously within a few days; however, severe cases may necessitate hospitalization and emergent care. Some evidence implies that infertility treatments may increase the risk of gynaecologic or breast cancer. Treatments for infertility have increased the incidence of twin and higher-order multiple births, placing mothers and unborn children in danger. Despite the fact that medical treatment for infertility is effective for many couples, some may require riskier, more expensive treatments.

Are you and your partner Planning for a pregnancy…

Preconception planning

Have you received rubella vaccination?

Rubella, or German measles, is an infectious virus. Fever, sore throat, gland enlargement, and rashes are symptoms of the flu. Not all afflicted individuals exhibit the above symptoms. People without symptoms can transmit the virus.

How does virus transmission occur?

Airborne fragments transmit pathogens. The virus induces rashes after two weeks. From one week prior to rash appearance to four days after, the condition is contagious.

How does rubella influence foetuses?

Nine out of ten infants with congenital rubella syndrome contract the virus during the first three to four months of gestation, when the mother lacks immunity.

Congenital rubella syndrome?

These dangerous conditions can impair a child's brain, eyes, hearing, or heart.

Are you safeguarded?

Rubella vaccination or two MMR injections administered three months apart offer protection. However, if you are dubious of your immunization status, you should undergo a blood Rubella IgG test prior to conceiving. If you test positive for Rubella IgG, you are immune to the virus and can plan a pregnancy.

Rubella IgG-negative?

If negative, procure the Rubella vaccination and plan pregnancy after three months.

What if I become pregnant immediately after vaccination?

Ideally, conception should occur at least one month after vaccination, but the vaccine does not cause congenital rubella syndrome.

What should expectant rubella-infected women do?

If you are expectant and susceptible to rubella, avoid children with flu-like symptoms or rashes. Vaccination cannot occur during pregnancy. Take the vaccine before departing the hospital after giving birth.

Vaccination during lactation poses no risk to the infant.

Before becoming pregnant, verify your immunity to rubella.

Obstetric cholestasis(OC), also called intrahepatic cholestasis of pregnancy (ICP), is a liver disease that can happen during pregnancy and could be fatal. To help you with digestion of food, your liver sends bile salts to your intestines. In maternal cholestasis, there is a buildup of bile salts in the blood due to this condition.

Treatment: OC goes away after giving birth.

It can be passed down through families(hereditary), but it can also happen on its own. It is more prevalent in women from India and Pakistan. OC is more likely to happen again if you had it before.

Preterm or stillbirth pregnancy’s are associated with higher risk. A stillbirth after 37 weeks can be prevented by inducing labor or doing a caesarean section to save the baby and reduce the risks to the mother.

Symptoms: Extreme itching all over the body without a rash, usually in the last four months of pregnancy. Some women may even get a very bad rash that they can get rid of. Some other signs are dark coloured urine, jaundice, and passing pale coloured faeces. Liver function tests(LFTs) are used to identify OC. Your doctor will give you LFTs on a daily basis until your baby is born to check on your health. If your LFTs are normal but you still have severe itching, they may be checked every week or two.

Calamine cream can help stop pregnancy-related itching. Some bile salts and medicines for itching might be safe to use while pregnant.

If OC makes it hard for you to absorb nutrients and vitamins, you may need to take multivitamins and vitamin K tablets.