Fetal Movements

Fetal Movements

During pregnancy, it is a pregnant women’s ultimate joy to feel the baby’s movement. It further increases the bonding with the baby.

Fetal movements are perceived by the women as a sensation of discrete kick, flutter, swish or roll. Movements are first perceived by the mother between 18 and 20 weeks of gestation. Women in their first pregnancy may perceive movement much later than 20 weeks of pregnancy, but women who have been pregnant before may perceive fetal movements as early as 16 weeks pregnancyin the subsequent pregnancies.

Fetal movements provide an indication of the integrity of the central nervous and musculoskeletal systems. The normal fetus is active and capable of physical movement, and goes through periods of both rest and sleep.

The number of spontaneous movements tends to increase until the 32nd week of pregnancy. From this stage of gestation, the frequency of fetal movements plateaus until the onset of labor; however, the type of fetal movement may change as pregnancy advances in the third trimester. There is no reduction in the frequency of fetal movements in the late third trimester.

By term, the average number of generalised movements per hour is 31 (range 16– 45) and the longest period between movements ranging from 50 to 75 minutes. From as early as 20 weeks of gestation, fetal movements show diurnal changes. The afternoon and evening periods are periods of peak activity. Fetal movements are usually absent during fetal ‘sleep’ cycles, which occur regularly throughout the day and night and usually last for 20–40 minutes These sleep cycles rarely exceed 90 minutes in the normal, healthy fetus.

There is some evidence that women perceive most fetal movements when lying down, fewer when sitting and fewest while standing. Sedating drugs, alcohol, cigarette smoking is associated with a decrease in fetal activity.

Women are advised to be aware of their baby’s individual pattern of movements. If at any time they feel that the movements are reduced or absent then they are advised to lie on their left side and focus on fetal movements for 2 hours. If they do not feel 10 or more discrete movements in 2 hours, they should contact their doctor.

The doctor will usually do a complete assessment and may be also record the fetal heart sounds on a machine which is called as the NST. In some cases the doctor may need to assess the blood flow to the fetus via an ultrasound Doppler assessment. In case there is any compromise in the fetal wellbeing then the doctor will take an appropriate action depending on the period of gestation and various other parameters.

So enjoy the flutter of the baby in your womb - the utmost joy of life within life.

PUBERTY

Puberty is the process of biologic & physical development through which sexual reproduction first becomes possible. various physical changes occur during puberty

They are

· Accelerated growth

· Breast development & growth

· Pubic & axillary hair growth

· Menarche -i.e. appearance of 1^st menses

(ovulation usually occurs 1-3years after menarche)

· Most girls get their 1^st menses between 9yrs to 16yrs. mean age is 12.8yrs

If a young girl

1. Does not have menses by age of 14yrs and also secondary sexual characteristics

Or

2. No menses by age of 16yrs despite secondary sex characteristics

Then she would need further investigation. One should then see a gynecologist .

x-ray in pregnancy

X-rays in pregnancy

Diagnostic x-ray is a frequent source of patient anxiety in pregnancy

It is important to note that

1. No single diagnostic x-ray procedure is enough to threaten the wellbeing of the embryo or fetus

2. Risk of fetal anomalies ,growth restriction spontaneous abortion are not increased at exposure level of <5 rads

3. MRI and ultrasound are safe in all stages of pregnancy

4. Radio opaque and paramagnetic contrast agents are unlikely to cause harm; but should be used only when the benefit justifies the potential risk to the fetus.

5. Use of radio-active isotopes of iodine is contraindicated in pregnancy.

Prevention of malaria

Prevention of Malaria

Malaria is a very common infection and can be life-threatening but it is preventable. Malaria is caused by the bite of the female Anopheles mosquito.

Malaria infection in pregnancy carries significant risks to mother and baby. Miscarriage, stillbirth and premature labour are the main complications of malaria.

Various measures can be taken to prevent malaria

The ‘ABCD’ of malaria prevention is as follows:

● Awareness of risk

● Bite prevention

● Chemoprophylaxis

● Diagnosis and treatment which must be prompt

Education about the cause and symptoms of malaria (such as a fever with chills) is useful.

Bite Prevention measures include

· skin repellents

· knock-down mosquito spray

· insecticide-treated bed nets

· clothing and room protection

The anopheline mosquito has different preferred biting times in different parts of the world. But the maximum risk period is from dawn to dusk.Therefore the mosquito bite prevention measures need to be applied 24 hours a day.

Skin repellents containing 20% DEET

Have been used and there are no apparent adverse effects

Knock-down mosquito sprays:

Permethrin and Pyrethroids sprays kill resting and flying mosquitoes. A can of insect spray active against mosquitoes is useful to help clear the room of mosquitoes. Pyrethroids will quickly kill mosquitoes and are the preferred ingredient in sprays, while permethrin will both repel and kill mosquitoes when used regularly in the same room.

Insecticide treated bed net

Long lasting pyrethroid-impregnated bed nets offer significant protection.Nets are now recommended by the World Health Organization for all pregnant women

Clothing that covers the body and forms a barrier from biting mosquitoes will also reduce the risk of malaria.

After sunset, long sleeves, long trousers, loose-fitting clothing and socks, regardless of colour, are recommended. Clothes can be impregnated with permethrin or permethrin or DEET can be spayed on to the clothes.

Drugs for malaria prevention

it is important to note that there is no drug that is 100% protective in preventing malaria. The choice of drug depends on various factors.

Women planning pregnancy and travelling to a destination where there is a risk of contracting malaria should note that

1. Malaria can cause harm to the pregnancy. Malaria is associated with increased risk of miscarriage.

2. Prophylaxis is not 100% effective

3. Women should try and avoid travel to endemic places or choose an alternative destination. If it not possible to delay either the pregnancy or the travel plan, then they should take prophylaxis.

4. They are also advised that they should avoid getting pregnant till the drug is completely excreted from the body. Thus they can avoid any inadvertent exposure of the fetus to the drug in the first trimester.

5. Nevertheless, if there is an unplanned conception while taking malaria prophylaxis, it is not necessary to do termination of pregnancy, as the risk to the fetus is low.

6. Mefloquine is essentially the only drug considered safe for prophylaxis in pregnant travellers in the second and third trimesters. The use of mefloquine in the first trimester may still be justified in areas of high risk of acquiring falciparum malaria.

This article is meant only to provide information and not be a substitute for medical opinion.

IT IS WITH GREAT PLEASURE THAT I INFORM ALL MY FOLLOWERS THAT I HAVE NOW ATTAINED THE TITLE OF

THE 'FRCOG'

AFTER 12 YEARS OF MRCOG THE ROYAL COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS.... IN THE UK, DOES AN ASSESSMENT OF YOUR PERFORMANCE AND THEN CONFERS ON YOU THE TITLE OF FRCOG ...... I.E. FELLOW OF THE ROYAL COLLEGE

THE CONVOCATION FOR THE SAME WAS CONDUCTED IN LONDON AT THE ROYAL COLLEGE ON THE 23RD SEPT 2011.

HERE I WANT TO THANK MY PARENTS FOR ALWAYS BEING THERE FOR ME , ENCOURAGING ME AND SUPPORTING ME ALL THE WAY THRU. NONE OF THIS WOULD BE POSSIBLE WITHOUT THEIR SUPPORT.

I ALSO THANK ALL MY FAMILY MEMBERS, FRIENDS WELL WISHERS AND PATIENTS WHO HAVE SUPPORTED ME ALWAYS.

Cervical Cancer - Role of HPV Vaccine

Cervical Cancer – Role of HPV vaccine

Article contributed By
Dr Sangeeta Agrawal
Consultant Obstetrician and Gynecologist.

In India cervical cancer is the commonest cancer to affect women, there are various factors that increase the risk of cervical cancer; such as malnutrition, low socio-economic status, multiple sexual partners, smoking etc.
Human papilloma virus infection is also an important cause of cervical cancer there are many types of HPV. They are classified as High risk and Low risk.
High risk types cause genital cancer and the low risk types cause genital warts.
HPV can spread due to skin-to-skin contact. It does not require penetrative intercourse.

One can acquire the virus at any time and then it may persist in the cells for a long time. It will then induce changes in the cells that over a long period of time lead to precancerous and then cancerous changes.

The HPV infection may not produce any symptoms. Taking vaccination against HPV can prevent cervical cancer. The vaccines contain some strains of the virus in the antigen form. These then help one to develop antibodies to the viral antigen.

All women can take the vaccine. It is particularly meant for young girls who have started sexual activity. It is not recommended for girls below age of 10 years. It should be avoided during pregnancy.
The dose is as follows 3 doses to be given intramuscularly in the deltoid muscle At 0, 1 month and 6 months interval.
It is imperative to remember that this vaccination does not take away the need to do regular screening for cervical cancer i.e. Pap smear.

exercise in pregnancy

Exercise in pregnancy
Contributed by Dr Sangeeta Agrawal
Consultant Gynecologist and Obstetrician.
E mail. sangeetaagrawal@yahoo.com

Exercise should form an important part of our daily lives. Exercise promotes a sense of well-being. Daily routine activity such as climbing stairs, walking to the train or bus stop, shopping for groceries, all involve some form of exercise. But yet it is important to do exercise in an organized manner for a fixed period of time. Further it is important to do exercise in pregnancy.

The aim of exercise during pregnancy is to stay fit. Exercise improves muscle tone and strength. It makes it easier to carry the weight one gains during pregnancy. It helps relieve generalized aches and pains, lower back pain and reduce varicose veins and swelling of the feet and ankles.

Exercise during pregnancy may help to prevent development or worsening of medical problems such as diabetes and blood pressure in pregnancy.

Exercise during pregnancy helps to prepare for the physical challenge of labor. Appropriate exercise can help women to breathe well during contractions, stretch the perineum muscles and have toned abdominal muscles. This may help reduce the duration of labor.

Exercise may be of two types.
Aerobic exercise: - such as swimming, running, fast walking, aqua aerobics and dancing.
Muscle strengthening exercise. This involves slow, controlled movements that help build strength of certain muscle groups and weight bearing exercises.

During exercise it is advisable to
Drink lots of water before and during exercise
Avoid over-exerting yourself
Avoid exercising in a very hot and humid climate
Avoid exercises which involve lying flat on the back
Do warm-up and cool-down exercises
Consider wearing pelvic support belts during exercise
Avoid exercise at altitudes over 2500 metres
Avoid sports where there is a risk of being hit in the abdomen, such as kickboxing, or falling due to running such as football, horse riding and cycling.
Avoid scuba diving for entire pregnancy because the baby has no protection against decompression sickness and gas embolism under water.
Exercise for 45 minutes at a time. Do not over exert.
After delivery one can start walking and simple stretches immediately, and then gradually progress in intensity and duration. Pelvic floor exercises are particularly useful to tone the perineum.

When one is exercising then one should look out for the following symptoms. And if any of this happens then one should stop exercise

· feeling faint/ giddy
· pain or palpitations in your chest
· pain in your abdomen, back or pubic area
breathlessness
· weakness in your muscles
· painful uterine contractions or preterm labour
· fewer movements from baby
· leakage of ‘waters' (amniotic fluid)
· bleeding.
Under these circumstances one must seek the opinion of the doctor.