PROBLEMS IN EARLY PREGNANCY

One of the earliest predicaments to confront a woman who has missed one or two periods, involves this all absorbing question, “Am I pregnant?” There are several simple techniques to determine pregnancy with reasonable certainty, right within one’s own home. A suspicion arises when there is a miss of the normal menstrual period. If menses have been regular for several months, then the intuition heightens. Many women have months when they skip the cycle normally. Others have periods too scant to notice. Then the diagnosis of pregnancy becomes more difficult.
Symptoms of pregnancy may be present. You may experience a feeling of nausea, typically in the morning. This is occasionally associated with prolonged vomiting lasting throughout the day. The breasts may swell and become more tender than is usually associated with the premenstrual state. A slight change may occur in the vaginal discharge. Occasionally, a woman who has had previous children just “feels pregnant.” In pregnancy after three to four months, a “lump” may actually be felt above the pubic bone, located in the lower abdomen. This is probably the enlarging womb. By five months gestation it will usually reach to the navel, with an obvious rounded prominence in the lower abdomen. Fetal movements may be sensed at four to four and a half months, though they are sometimes detected earlier by experienced mothers carrying their second or third child.
In most pharmacies today, you can purchase a urine pregnancy test kit. This analysis very simply measures the amount of HCG (Human Chorionic Gonadotropin), a hormone secreted by the developing placenta. A positive test for pregnancy develops within three to six weeks after conception. Use a concentrated morning urine sample for best reliability. If performed according
to directions, these tests are quite dependable in confirming the suspicion of pregnancy.
Vague abdominal pains are sometimes felt in early pregnancy. Pelvic pain may occur from pressure on an enlarged ovary, or from a “tilted” uterus. As it enlarges, the organs become tighter in the pelvis, while the womb has not yet risen into the abdominal cavity. Pain could be related to constipation, or to cystitis. Usually, a bladder infection is characterized by burning combined with a frequent urge to urinate. Stretching of the ligaments that support the uterus may produce pain. In later months, the pressure of a fetal part on a pelvic nerve or a sudden shifting of the baby within the womb may give rise to such symptoms. Usually reassurance is all the patient needs. Severe pain or sudden changes in health status should be called to the attention of a physician immediately, however, since it could be an ectopic (tubal) pregnancy. If this goes unrecognized it could rupture, with internal hemorrhage and potential disaster. Appendicitis may occasionally be superimposed upon pregnancy, requiring early diagnosis and prompt surgical treatment as usual.
Vaginal bleeding sometimes occurs, even after pregnancy begins. Usually this appears scant and transient, but at times it may be profuse. When an actual hemorrhage develops after pregnancy has established, this constitutes an obvious threat of miscarriage. The presence of regular contractions and pelvic pain, combined with vaginal bleeding, should alert to this possibility. At times a miscarriage may occur with the complete passage of the placenta and the subsequent stoppage of bleeding. If incomplete expulsion of the placenta or fetal tissue occurs, a simple operation, called a D and C (dilation and curettage), should be performed, so the bleeding will stop and the uterus can return to its normal size. Fever in the presence of a miscarriage is a more ominous sign, as it probably indicates the presence of pelvic infection.
For treatment of threatened miscarriage, bed rest is always advisable. The absence of straining, standing, or moving about lessens the flow and usually decreases the likelihood of a miscarriage. Sexual intercourse should be avoided in early pregnancy, particularly near the times when a menstrual period would otherwise occur. Uterine cramping and the likelihood of miscarriage is greater at these cycles, for reasons yet unknown. Hormones are no longer given routinely to mothers threatened with miscarriage. They are powerless to stop the inevitable. Furthermore, progesterone concentrates may cause damage to the fetus, if it is carried to term. Scientists believe that many spontaneous miscarriages are the result of some chromosomal defect, which
otherwise would have led to congenital deformity. They are eliminated by nature before the pregnancy goes too far. This is of considerable consolation to parents, suddenly disappointed by the premature loss of a long-looked-for baby. Most couples can wait a few months, then try again.
One of the more troublesome conditions of early pregnancy, sometimes lasting for months, is an upset stomach. Called “morning sickness,” for obvious reasons, nausea and vomiting tends to herald the onset of pregnancy. Although only a few ladies find it incapacitating, these symptoms tend to hinder proper nourishment, so important in the early months of pregnancy. This nausea may last throughout the day. On the other hand, it may be relieved by eating some crackers or other form of dry food. Frequently, the appetite completely changes, and the “lady-in-waiting” craves foods that were formerly disliked. In extreme cases this so-called pica (abnormal craving) is manifested by the “clay eating” habit of southerners, or the strange love for “pickles and ice cream” that ordinarily seems like a repulsive combination.
Mothers need to be careful that their appetites are controlled by reason when such cravings become abnormal. Where vomiting in pregnancy becomes persistent, hospitalization may prove necessary. One or two days of intravenous feedings is normally sufficient to bring back a normal digestion once again. Emotional contributions to this gastric problem are frequent. These can be related to ambivalence about being pregnant, or an underlying temperament of nervousness manifested in an unusually sensitive stomach. Nevertheless, the physiologic and hormonal changes that occur are profound. Such endocrine considerations may well explain these early digestive symptoms. A tolerance for food usually emerges by the fourth month, enabling a normal digestive tone to continue for the remainder of pregnancy.
Adequate fluid intake is vitally important from the start. It is suspected that the common, insufficient intake of water is one principal cause of persistent nausea and vomiting. Drink at least six to eight glasses of water per day, at whatever temperature is best tolerated by the sensitive stomach. If the mother avoids soups and creamed mixtures, and chews thoroughly a rather dry meal of whole grain crackers, breakfast cereals, or raw vegetables, her food will stay down better and permit the best nutrition at this critical stage. Vaginal discharge is often troublesome during the latter months of pregnancy. This may be due to the parasite Trichomonas, but is more commonly caused by a buildup of yeast or Monilia (Candida albicans).
Hormone changes combined with increased perineal moisture and warmth, create an environment favorable to the growth of these organisms. Diabetes mellitus, particularly aggravates the tendency to develop yeast infections.
Administration of hormones such as the birth control pill may produce a diabetes-like state in non-pregnant women. However, pregnancy increases this trend. Nylon underwear, panty hose, and tight slacks tend to increase the propensity for vaginitis. This is because greater warmth and moisture are produced in the perineum when one wears those synthetic fabric materials. Air circulation around the body and “breathing” of the skin is impeded. Then it leads to the rapid multiplication of yeast germs with such unpleasant symptoms as discharge, burning, itching, and skin rash. Gentle vaginal douches, with a dilute vinegar solution (one tablespoon of white vinegar to one quart of warm water) can help decrease the discharge and restore normal acidity to the birth canal. Specific agents are available to help in acute stages (such as Massingill products). However, the intestinal tract always harbors these germs, so it is impossible to completely escape from them. Therefore,you will find it preferable to build up resistance and let improved health of the body create its own defense. Marital relations should be avoided, not only when discharge or infection is present, but during any time of spotting or uterine cramping. Moreover, for at least four to six weeks prior to the birth of the baby, intimate relations should likewise be curtailed, since a significantly increased risk of infection in the amniotic fluid surrounding the baby has been linked to intercourse at this stage. Sexual continence at this critical time will be rewarded with better health, as well as peace of mind.