Pregnancy: Things you should be aware of at different stages

At 30 weeks, (about seven months of pregnancy), 32-year-old Sylvia Nalwanga travelled to the United States for a workshop. Before taking the trip, she consulted her doctor, who after carrying out a medical examination, said she was in good health to travel, but advised her take a day of rest after reaching her destination.

Monday May 5 2014

Pregnant women wait to receive medical care at

Pregnant women wait to receive medical care at Mulago hospital. Expectant mothers are encouraged to attend antenatal care services to avoid potential risks to their pregnancies. PHOTO by Rachel Mabala 

By Sarah Tumwebaze & Pauline Bangirana

At 30 weeks, (about seven months of pregnancy), 32-year-old Sylvia Nalwanga travelled to the United States for a workshop. Before taking the trip, she consulted her doctor, who after carrying out a medical examination, said she was in good health to travel, but advised her take a day of rest after reaching her destination.

When she arrived at her destination, Nalwanga says she felt normal and after having a meal, she retired to bed.
“However, I woke up at around 2am and found myself lying in a pool of blood. I was very scared and called the front desk of the hotel to tell them what had happened but I was told the only way I could get to a hospital was if I had insurance,” Nalwanga says.

She adds: “I did not have US medical insurance and I was not yet in touch with the people that had organised the workshop. So I sat up in bed and wept till morning because I knew I had lost my baby.”
However, when Nalwanga finally got in touch with her hosts at about 8am, she told them what had happened.
“They did their best and got me to hospital within 30 minutes. When the doctors checked me, they told me my baby was fine and I could also see on the screen that there was a heartbeat. I was very relieved,” she explains with a teary smile.

While Nalwanga was lucky that her baby was alive after the incident, the doctors say the bumpy flight had upset the uterus and affected the baby.
Experiences such as Nalwanga’s happen too often, and while they might not be as a result of a bumpy flight, anything that upsets the foetus is likely to affect the developing child in the womb.

So, what happens during the development of the foetus?
Dr Godfrey Alia, a gynaecologist/obstetrician at Mulago National Referral Hospital, explains that while a pregnancy is carried for nine months, this duration is further divided into three trimesters.

First trimester
According to Dr Alia, the first trimester is between the first to 14 weeks of pregnancy, which is around three months and a half.
“These are the first stages when the different organs of the baby are forming. It is a crucial period and anything that goes wrong during this period may lead to an abnormality in the baby’s development or even a miscarriage.

Body changes
At this stage, the woman also starts experiencing body changes. “Her breasts will become tender and sensitive and she will feel tired most of the time because of the excess activity the body is undergoing,” says Dr Alia. This is also the stage when the baby’s development can easily be affected by what the mother eats or drinks.

“It is at this stage that you are supposed to feed well for the foetus to get all the nutrients it needs. You should also avoid taking local herbs, alcohol and tobacco because these might either causes an abortion or a mal development of the baby.”

Dr, Charles Kiggundu, a consultant gynaecologist and president of the Association of Obstetricians and Gynaecologists of Uganda, explains that during the first seven days of conception, the cells begin to multiply, and in the second week, the baby is ready for implantation.

Because it is a critical stage of pregnancy, a number of things can happen. “The implantation of the baby can take place outside the uterus, a condition known as ectopic pregnancy,” says Dr Kiggundu. However, Dr Gilbert Ahimbisibwe of the Women’s Hospital International and Fertility Centre, Bukoto notes that if abnormalities such as an ectopic pregnancy are detected early, they can be corrected or managed.
This, he says, can be done through an operation.
If implantation is successful, division of cells occurs, and this helps in forming major organs of the body such as the brain, stomach, heart, genital organs, skull and the placenta.

Second trimester
This is the period of pregnancy between 14 to 28 weeks (from three and a half to six months).
Dr Alia says by this time, most of the organs have developed and the baby has started gaining weight.
He, however, notes that at this stage, some women are prone to malaria, common infections and pneumonia.
“By the second trimester, a woman’s immunity has gone down and she is susceptible to infections, malaria and pneumonia. All these come with a fever and the change in temperature has an effect on the development of the foetus. This might lead to an abortion.” Dr Ahimbisibwe notes that medicines taken during this period could also cause defects to the unborn child.”

However, this stage of pregnancy is when the unborn child starts to function or show an ability to function. Possible pregnancy-related risks during this period may include abnormal growth of the baby. If there is exposure to radiation, smoking or alcohol, there is delayed process in development.
It is also at this stage that deficiencies begin to show. However, Dr Kiggundu notes that, “If a woman gets a premature birth before five months, chances of the baby’s survival are minimal. He attributes this to the lack of adequate means to save the baby.

Third trimester
This is the period between six to nine months and Dr Alia says at this stage, the baby is fully formed. It increases in weight, the liver functions and begins to remove bad substances from the body, and the skin also forms.
Besides, the lungs begin to expand so as to sustain breathing, and the enzymes also start to work. “There are active movements and if the expectant mother has a poor supplement of body nutrients, this will affect the baby for instance lack of enough blood could lead to a child being anaemic.”
At this stage, Dr Ahimbisibwe notes that there are risks of miscarriage and this is due to a weak cervix although he notes that it can be noticed by a doctor and prevented.

As the pregnancy gets into the ninth month, the tissues in the pelvic region start to soften in preparation for the delivery of the baby. “During this time a woman will experience joint pain, which should not be a cause for alarm,” Dr Alia says.

During delivery
Dr Kiggundu notes that it is during delivery that babies are at the greatest risk. “They get exposed to infections and some even die before they are fully out,” he says.

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