Obstetrics

You're pregnant! What to expect in the first weeks

Many women first suspect they may be pregnant when their period is overdue, but there are several other symptoms and signs which you may notice. The way to confirm that you are pregnant is obviously to check with a pregnancy test, most of which will now give a positive result around the time of your expected period.

Signs and symptoms of early pregnancy vary between women and between pregnancies in the same woman, so don't worry if you don't have them all!

Tiredness

Feeling more tired than usual, is a very common early symptom, that may start to occur even before a missed period. This will tend to improve by the second trimester, after 12 weeks.

Breast Tenderness

This can be a very noticeable early sign. Increased hormone levels cause a growth in the breast tissue and increased blood flow, both of which make the breasts feel engorged and tender. The areola, the area around the nipple becomes darker in colour. Small raised protuberances, on the areola, 'Montgomery's tubercles', become more prominent.

Nausea

Most women experience some degree of sickness in the first weeks of pregnancy, particularly in the first pregnancy. This can occur at any time during the day, although it is often referred to as 'morning sickness'. Generally, this resolves by around 16 weeks.

Other common symptoms:

Constipation – increased levels of progesterone, which relaxes the smooth muscle in the intestines, can cause your bowels to become a little sluggish.

Urination – Passing urine more frequently is at first due to changes in hormone levels, and later also due to the growing womb pressing on your bladder.

For more information, or to arrange a consultation, contact Mr Chilcott.

Flying Whilst Pregnant

Safety for your baby

As long as your pregnancy is straightforward, and you have not had any significant complications, flying during pregnancy will do no harm to your baby. Your baby is well protected, and changes in pressure associated with flying will not cause any problems, nor will it increase your chances of going into labour during your trip.

Airlines policies vary, but most will require a doctor's letter confirming they are happy for you to fly, once you are more than 28 weeks. Any time after 37 weeks is the normal time to give birth (34 weeks for twins). Therefore, flying at this time carries more of a risk of you going into labour during the flight. Airlines will generally be reluctant for you to travel at this time. The crew will not be experienced in assisting with childbirth, nor if there are any complications. The pilot would probably have to divert the flight to enable you to be taken to hospital. I would not advise you to be flying at this time.

Safety for you - DVT – Deep Venous Thrombosis

Being pregnant in itself increases the risk of venous thrombosis (blood clots in the leg veins, DVT). DVT can lead to Pulmonary Embolism, PE, a potentially fatal condition, with clots passing to the lungs. Blood clotting factors increase during pregnancy as a natural defence against excessive bleeding at the time of birth. The effect lasts for 6 weeks after birth as well). Increased risk of DVT is an unfortunate consequence of this. Sitting for long periods of time in cramped conditions, further increases the risk due to reduced circulation of blood in the legs – as happens on flights. Additional risk factors include obesity, previous history of DVT and dehydration.

Reducing the risk of DVT

The risk is more, the longer the duration of the flight. Suggestions to reduce the risk:

For more information, or to arrange a consultation, contact Mr Chilcott.

Pre-eclampsia

Pre-eclampsia is a common condition, the exact cause of which is poorly understood, which can complicate the second half of pregnancy. It occurs in 2-3% of pregnancies. Often it is mild and without symptoms. It is detected by routine measuring of blood pressure and testing for protein in the urine, as high blood pressure and proteinuria are the distinguishing features. Swelling due to fluid retention can also occur, but swelling of the ankles without raised blood pressure or proteinuria is common in pregnancy anyway, and not usually a cause of concern. It is important to detect the condition, because worsening pre-eclampsia has implications for the health of both mother and baby. 1 in 200 pregnant women develop severe pre-eclamsia. In the severest form, pre-eclampsia becomes eclampsia, where maternal convulsions occur.

Pre-eclampsia affects the development of the placenta and can affect the baby's growth in the womb. There may also be a reduced amount of water (amniotic fluid) around the baby in the womb. If the placenta is severely affected, the baby can become distressed or even die. Monitoring aims to pick up those babies who are most at risk.

Risk factors

Your risk of developing pre-eclampsia can be increased if any of the following apply:

Management

Mild cases are managed with just regular monitoring of blood pressure and urine testing. Extra ultrasounds may be advised to check your baby's growth and well being are not being affected, as can occur. Medications to lower blood pressure may be needed, and possibly hospital admission for closer observation.

Severe pre-eclampsia is indicated by very high blood pressure, and worsening kidney function with greater amounts of protein being passed out in the urine. Symptoms include severe headaches, blurred vision, abdominal pain and marked swelling of the face. If these symptoms develop, you must contact your doctor immediately.

The only cure for pre eclampsia is to deliver your baby. This may mean inducing labour, or sometimes delivering by Caesarean section.

The condition may take a while to resolve after delivery, so careful monitoring may continue for a few weeks.

For more information, or to arrange a consultation, contact Mr Chilcott.

Induction of Labour

Under certain circumstances, induction of labour may be recommended, rather than waiting for labour to start naturally.

There may be concerns for the wellbeing of either the mother or the baby, where it becomes necessary to expedite delivery, such as pre-eclampsia in the mother, or poor growth of the baby.

The most common indication for inducing labour is when the baby is overdue. It is well established that pregnancies which go beyond 42 weeks carry higher risk of complications and even higher stillbirth rates. Therefore it is routine to offer induction of labour before this time.

Another common indication is where a mother's waters break after 34 weeks, but labour does not start. Induction is then recommended as once the waters have broken, there is a risk of bacteria from the vagina reaching the baby and causing infection.

The process

If the neck of the womb, cervix, has not yet started to soften, shorten and dilate in readiness for labour, a hormone, prostaglandin, is used to facilitate the above changes. This is commonly given as a gel into the vagina. This may needed to be repeated at intervals of 6 hours, until it is possible to 'break the waters'. This is termed A.R.M. or 'Artificial Rupture of Membranes'. Another hormone, oxytocin may then be given via an intravenous line to ensure there are regular, effective contractions.

For more information, or to arrange a consultation, contact Mr Chilcott.