Monday May 5 2014

Pregnancy: Things you should be aware of at different stages

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.

According to Dr Ahimbisibwe, because this is a critical stage, it is recommended that all expectant mothers ensure to give birth in a health facility where the health personnel are able to identify risks that may occur during or shortly after birth to both the mother and baby.
This is because delivery comes with a high chance of bleeding or a risk of obstructed labour, all of which can put the life of the mother and child at risk.

“The baby might be lacking enough oxygen during and after labour and if there is too much formation of fluid in the brain, the baby could suffer from infections like meningitis,” Dr Ahimbisibwe notes.

Weeks 37 to 42
This period is classified as term. This means that the baby has fully developed, and is ready to be delivered. This is also classified into three.
Early term occurs between 37 and 38 weeks. However, this is complete because the baby’s bones are soft enough and it can easily pass through the birth canal.

Term occurs between 39 and 40 weeks. At this stage, the baby can pass with less difficulty. At this stage however, Dr Kiggundu notes that a woman should be mentally and physically prepared for child birth because delivery is not an easy thing and labor pains can be painful.
Late term happens between 41 and 42 weeks, and at this stage the baby’s bones are beginning to get stuck and as such, the child must be delivered or else it could complicate the process thereafter.

what happens after the birth of the baby?
Dr Godfrey Alia, a gynaecologist/obstetrician at Mulago National Referral Hospital says after giving birth, a woman’s body returns to its normal state after about two months.

He advises that after delivery, a mother needs to look out for profuse bleeding, a smelly discharge and a fever in both the mother and the baby.
“All these are signs of either a complication or an infection. When you notice them, you need to see a doctor immediately because they could lead to death, especially if these symptoms are accompanied by bleeding,” says Dr Alia.
Dr Gilbert Ahimbisibwe of Women’s Hospital International and Fertility Centre Bukoto says: “As a result of delivery, a mother might be at risk of bleeding which is known as secondary bleeding and puerperal infections which can lead to death if not treated.”

He says even after birth, a woman needs to make several visits to the doctor until she is declared risk free although he notes that after birth, the effects of pregnancy tend to wear off after six weeks.
He also notes that a child could bleed to death due to the lack of Vitamin K.
According to Dr Ahimbisibwe, some hospitals do not pay attention to women after birth, and an important factor that may be ignored is blood incompatibility of the mother and child.

This, he says may cause problems with future pregnancies if it is not addressed as soon as a mother has had a delivery.
Therefore, the care that you will take during pregnancy should continue after birth, to ensure the safety of both the mother and the baby.

Dr Charles Kiggundu, a consultant gynaecologist notes that exposure to radiation, habits such as smoking, consuming alcohol and drugs could be harmful during pregnancy, as this increases the baby’s risk of developing abnormalities.

He says during all the stages of pregnancy, a woman should instead eat a well-balanced diet. Lack of essential nutrients may affect the development of the baby. In such cases, the pregnancy risks abnormalities or defects that could affect the brain, including abnormal closure of the spinal cord or abnormality of the heart and absence of the development of the skull.