Pregnancy Road map for a successful outcome !

Pregnancy Roadmap is actually a strategy for a positive outcome and likewise the prenatal care or the antenatal care is actually such a clinical tool which if used appropriately can go a long way in ensuring optimal outcomes.

Pregnancy, per say, is a normal physiological phenomenon of woman’s body and a designated natural reproductive function. Despite this, we see that the mother is put through investigations, test and treatments for an essentially normal bodily function. We truly need to understand this.

Mother’s health in any country is an important marker of the entire health system of the country and this is assessed by measuring the maternal mortality ratio which means the number of women who succumb to pregnancy related complications out of 1000 live births. And the ratio is remarkably high in our country still despite the efforts by the government and the gynecological fraternity. I have had an opportunity of being on various such advisory bodies which primarily assess and discuss and plan these strategies for safe delivery and outcomes in pregnancy. And what I have come to conclude is that the women themselves too need to understand, cooperate, comply and take it upon themselves to successfully implement the strategy. Finally, the goal is to achieve a successful future generation and also without harming the mother.

Thus on the personal front it’s better if a mother understands what she has to deal with and is prepared, a lot can be achieved. Today, I am writing a broad outlook and the basic important assessment targets that are essential components of this roadmap

The initial assessment is important : and sooner the better 

First is confirmation of pregnancy which is progressive and inside the womb: very early pregnancy is confirmed to be viable and progressive by sonography( Ref pic ) wherein the fetal embryo and its heart activity is identified. This is usually done between 5 weeks to 10 weeks of pregnancy and this test is able to tell us the duration of the pregnancy correctly. Sometimes the mother’s dates may be wrong or there can be a delayed ovulation and therefore sonography confirms the pregnancy well being. Such early sonography also helps in correctly determining the expected date of delivery with more precision than later sonographic evaluations.

Second important aspect is to identify whether the mother is healthy. This is done by assessing the mother’s physical parameter and the height, weight and its ratio. Her general checkup to look for any signs of nutritional deficiencies, any physical abnormalities e.g: mother who has suffered polio, any underlying illness such as diabetes, heart disease etc. A thorough clinical examination is done to assess any abnormalities which the woman may not be aware. Many times the woman’s heart disease, diabetes or anaemic status is first identified during pregnancy.

To find out if the mother is taking any medications for any illnesses has recently suffered any ailments or has inadvertently taken medicines which can be harmful to the forming baby. medicines taken for treatment of cancer, fits, tuberculosis, acne or some antibiotics can be harmful to the baby directly or indirectly and have to be evaluated and assessed.

Some ailments in the mother need to be assessed by laboratory tests: conditions such as anaemia, type of anaemia, hypothyroidism, diabetes, infections such as HIV AIDs, Hepatitis B or others can be done only by laboratory tests.

Ongoing assessments

It is essential that regular checkups are followed with the doctor as suggested as there are specific times for some special assessments. Also, this gives an opportunity to ensure proper growth of the baby and the adaptation of the mother to the pregnancy

1. Regular checkups are done to assess the weight gain, nutrition of the mother, the baby’s growth, blood pressure and general well being of the mother. I have already written about the weight gain, nutrition, and blood pressure during pregnancy before and you are requested to refer to that

2. Pregnancy is a metabolic and a hormonal overload on to the woman’s body and therefore some ailments such as diabetes and heart disease may be unravelled during pregnancy and may need evaluation through additional tests

3. Emerging abnormalities such as fetal growth restriction, any maternal infections, illnesses such as fever, loose motions, vomiting also are to be dealt with.

4. Vaccinations are offered to protect the baby and the mother from serious infections such as the flu and tetanus.

5. Special situations such as diabetic mothers, very young or older mothers, women with prior not so normal outcomes may need more intense follow-ups

Treatments

Micronutrient supplements are a common norm during pregnancy and are based on the fact that a regular diet may not suffice to reach up to the recommended requirement of these. And these are usually based on the duration of the pregnancy, diet assessment of them her and any specific background issue or an emerging finding.

Examples : Mrs Seema is now 39 years of age and has conceived after 9 years after her first child which is a girl. She was not very sure about this baby but now since she is 10 weeks pregnant has decided to continue the pregnancy.

Primary assessment has revealed that her dates are irregular, she is observed class 2 with BMI more than 34 she is anaemic with a haemoglobin level of 9g/dl .

Has thyroid problem with her TSH levels of 10.2 IU and is pre-diabetic with her HBA1C level of 8 g/dl.

Thus Seema willed to be first further evaluated, treated and a continuous surveillance will have to be done for a successful outcome.

So the road map of pregnancy does have the strategy and a purpose and also has scientific reasons for the tests and their timings. Next visit we will deal with the timelines observed for the various essential tests.