your miracle in making

Your Miracle In Making 01

Y O U RMIRACLE

IN MAKING

Your Miracle In Making 03Your Miracle In Making02

Your Miracle in Making

Editor: Dr Himanshu Bavishi

Dr Himanshu BavishiBAVISHI FERTILITY INSTITUTE Next to Adani CNG & Gajarawala Flats,Paldi # Roads,Paldi,Ahmedabad-380007 India. Phone: 079-40404646, 98795 72298

First Edition: June 2017

Price: Rs 450

ISBN: 978-81-932743-2-3

Published by:Pugmarks Mediaa,119, Swami Vivekanand Marg,Allahabad 211003 (UP), IndiaPh: 9956285988 Email: [email protected]

Cover Design: Raj Bhagat

Design: Team IVF India

Printed at: Vavo Prints, Bai Ka Bagh, Allahabad 211003 (UP)

Disclaimer:-Every attempt is done to provide latest and correct scientificinformation, in this book. However, every pregnant lady should takeadvice from her treating doctor about her pregnancy care. Everyindividual and even pregnancy is different and show different signsand symptoms as well as care. This book is for general informationpurpose only.

What do you think about this book? If you have any queries orsuggestions, please write to us: [email protected]

Brief introduction to the contributors

DR. HIMANSHU BAVISHIM.D. (Ob & Gyn)He is a senior Obstetricianand Gynecologist practicingsince the last 30 years. As aninfertility & IVF specialist hehas a vast experience ofmanaging pregnancies andchild birth, particularly forprecious and high riskpregnancies. He is a co-founder of World recognisedand India’s leading FertilityInstitute – Bavishi FertilityInstitute.

DR. FALGUNI BAVISHIM.D. (Ob & Gyn)She is a senior Obstetricianand Gynecologist practicingsince 29 years. She is aninfertility and IVF specialistwith special skills andknowledge of intricate andhigh technology IVF Labprocedures. She is the co-founder of – Bavishi FertilityInstitute.

C


Brief introduction to the contributorsBrief introduction to the contributorsDR. PARTH BAVISHIM.D. (Ob & Gyn)A young and dynamicspecialist he joined thefamily institute “BavishiFertility Institute.” After hismaster degree in Ob & Gy hedid his fellowship in FoetalMedicine and ObstetricUltrasound.He has obtained specialtraining at Diamond Institutefor infertility andMenopause, USA andHiroshima AssistedReproductive TechniqueInstitute, Japan. He isworking with Bavishi FertilityInstitute since 2012.

DR. JANKI BAVISHIM.S. (Ob & Gyn)An enthusiastic and sincerespecialist she joined thefamily Institute “BavishiFertility Institute.” Sheobtained her master’s degreefrom one of the oldestmedical college and biggesthospital of Asia, B. J. MedicalCollege. After Master Degreein Ob & Gy, she hascontributed enormously toBavishi Fertility Institutesince 2013. She did herspeciality infertility trainingat Diamond Institute forInfertility and Menopause,USA and Hiroshima AssistedReproductive TechniqueInstitute, Japan.

DR. PURVI SHAHM.B.B.S., D.G.O.Fellowship in Obstetric ultrasoundA dynamic gynaecologist with 14years experience and havingspecial training and fellowship inFetal Medicine. She is a part ofthe dynamic team of BavishiFertility Institute since the lastnine years.

DR. LEKSHMY RANAMD, DGO, MRCOG

DR. SUSHIL SHINDEMBBS, MS

DR. SONALI TAWDEMBBS, MS, DNB

DR. BINAL SHAHMBBS, DGO

Consultant Gynaecologists & IVF Specialists

07Your Miracle In Making06

About Bavishi Fertility InstitutesTHE INSTITUTEBavishi Fertility Institute, Ahmedabadwas established in 1986, as amaternity hospital. Continuousexpansion and modernization hasmade it one the most prestigiousfertility institute of India and theWorld. Today, BFI is one of India’sbiggest fertility institute and does oneof the highest numbers of infertilitytreatment procedures and IVFtreatment cycles.A strong team of more than 100experienced, qualified and dedicatedpeople, including 18 consultants,embryologists, IVF programcoordinators, counsellors, nurses andsupporting staff, help BFI maintainvery high standard of quality and care.Together we achieve a very highsuccess rate and patient satisfaction.Our ethics and transparency coupledwith commitment and innovationmatch with our motto -“TECHNOLOGY • TRUST” The BFI teamis ideal combination of EXPERIENCEAND ENTHUSIASM COUPLED WITHWISDOM AND VISION. Bavishi Bhagat FertilitY institute,

DelhiBavishi Bhagat Fertility Institute, Delhi, isstate of ART-IVF center promoted by BavishiFertility Institute Ahmedabad and Delhi’s ex-perienced and expert gynecologist Dr. Upasana Bhagat. The institute is located atan ultra modern multi specialty 100 bedhospital, Bhagat Chandra Hospital. Estab-lished in September 2009, Bavishi BhagatFertility Institute is located in a prime area ofDelhi, Dwarka. It is in proximity to domesticand International airport. BBFI Delhi offers

all fertility services of the same standards asBFI Ahmedabad. Senior consultant Dr. Up-asana Bhagat along with a dedicated team istaking care of the centre. Dr. Himanshu Bav-ishi regularly visits BBFI Delhi for ovum pickup, embryo transfer, and smooth function-ing of the institute. BBFI offers all fertilitytreatments under one roof. Located in thecapital of India, BBFI Delhi is also becominga preferred destination for IVF treatmentfrom people across the globe.

Bavishi FertilitY institute, MuMBaiEstablished in October 2010, BFI MUMBAI islocated at one of the most well connected-central and posh areas of Mumbai-Ghatkopar East. BFI Mumbai, offers allfertility services of the same standards underdirect supervision of BFI Ahmedabad. To in-crease the convenience of people ofMum-bai, BFI Mumbai has 5 sub centres at Borivali,Villeparle, Andheri, Dadar, Vashi and Thane.Couples can get all services at these subcentres. Women alone can easily continue

their treatment making it much more con-venient and sustainable. A team of 4 fertilityexpert gynecologists - Dr. Lekshmy Rana, Dr.Sushil Shinde, Dr. Sonali Tawade, Dr. RiddhiDoshi take care of the centres along with ateam of embryologist, counsellors, nursesand support staff. Dr. Falguni Bavishi and Dr.Himanshu Bavishi regularly visit BFI Mumbaito take care of ovum pick up, embryo trans-fer, consultation & monitoring of all opera-tions. BFI has shifted to a bigger and betterfacility in 2017.

FACILITIESSpread over 7 stories and 21,000 Sq. Ft.of space, BFI, has separate floors fordifferent departments.• INFERTILITYBFI offers all treatment optionsincluding, Endoscopy (Laparoscopy –Hysteroscopy), IUI, IVF, ICSI, Assistedhatching, Blastocyst culture, PGS, PGD,Egg/Embryo/Sperm donation, Egg/

Embryo/Sperm freezing and Surrogatemother.• FOETAL MEDICINE AND HIGH RISK

PREGNANCYDedicated foetal medicine unit hasyears of experience in managing highrisk and complicated pregnancies, i.e.twins, triplets or higher order multiplegestations, hypertension, gestationaldiabetes, growth restricted foetuses,

preterm labour pain, etc.• We offer following services for at risk

foetus.- Prenatal diagnosis of genetic

anomalies.- Prenatal diagnosis of foetal anomalies.

- Prenatal treatment of foetal anomalies.

- Foetal therapy including intrauterine foetal therapies

- Foetal surveillance


EDUCATIONAL ACTIVITIESt FOR MEDICAL FRATERNITY- BFI has organized many trainingsessions on various subjects for gynaecologists and other doctors.- BFI has organized many national andinternational level conferences, CMEs,workshops and round table meets.t FOR PEOPLE- Interactive patient counsellingseminars- Jan Jagruti Abhiyan

SOCIAL SERVICESn DIVYA SANTAN SANSTHAN and patientsupport group, DIVYA SANTAN PARIVAR- ‘Parivar Milan’n Education and research- Jan Jagruti Abhiyan “Public AwarenessPrograms’- Bavishi Fertility Institute supportsDIVYA SANTAN SANSTHAN for all itsactivities for providing ‘Information

Guidance, Inspiration and Solace’through its massive ‘Parivar Milan’Abhiyaan and many more activities.- DIVYA SANTAN ParivarA unique concept for the first time inIndia, of support group by successfulcouples for couples trying to conceive.- Thousands of people have benefittedfrom this mission in more than 694events across India, till June 2016.

PUBLICATIONS• FOR MEDICAL FRATERNITYIUI book written by Dr. Falguni and Dr. Himanshu Bavishi for consultantgynaecologist and pathologist forAssisted Reproductive Technique calledIUI. 3rd edition was published in 2007• FOR PEOPLEDev Na Didhela Mangine Lidhela: Aunique and first of its kind book of lifestories of parents of 222 IVF babieswritten by parents themselves!Vighna Dod : Book discusses variousdilemma, stress, psychological aspectsand more related to infertilitytreatment. Written by Shri AmrutbhaiPatel who has passed through thispainful journey of infertility treatment.• PATIENT INFORMATION SERIESSmall booklet written in simple and

easy language on various infertilityproblems and treatment options,available in Gujarati, Hindi, English,Marathi & Bengali.

Bavishi Pratiksha FertilitY institute, kolkataBAVISHI PRATIKSHA FERTILITY INSTITUTE, isstate-of-art IVF center promoted by BavishiFertility Institute, Pratiksha Group of Hospi-tals and Srishti Hospitals. The ultra-modernInstitute is spread across more than 8000sq feet and two floors and is located in aprime area of Kolkata. BPFI, Kolkata offersall fertility services of world class standardsand care. A qualified team of consultants,embryologists and other staff take care of

patient’s needs. The centre is designed andmade as per the highest standards of med-ical care and focused on specific needs ofinfertility management services. BPFI offersvarious, most reasonable ‘Value for money’price packages to suit the budget of everycouple. BPFI Kolkata is the preferred desti-nation for fertility treatment for couples ofWest Bengal and other neighbouringstates and countries.

Bavishi FertilitY institute, suratBavishi Fertility Institute Surat, was estab-lished in 2009. It is located in a prime area ofSurat, near the railway station in Param Doc-tor House. A qualified team of Dr. Usha Pa-toliya, Dr. Bipin Patoliya and Dr. HarshaUmrethiya take care of the patients of Suratand it’s vicinity, under the dedicated super-vision of Dr. Himanshu Bavishi, Dr. Falguni

Bavishi and their team of Bavishi Fertility In-stitute, Ahmedabad.BFI Surat, offers all fertility services with thelatest technology under one roof. The centreis designed and made as per the higheststandards of medical care and focused onspecific needs of infertility managementservices.

First ivF Babies Meet –2004For first of its kind,awareness programme,Bavishi Fertility Instituteorganized “IVF BabiesMeet” in 2004, to breakthe myths and spreadawareness about the

modern technology. More than 100 IVF babiesconceived at Bavishi Fertility Institute, participated.

Won the2017 “Excel-lence in IVF”Award from“MY FM”DivyaBhaskarGroup.Again be-come the first

Fertility Institute of Ahmedabad to winthis prestigeous award.

technical support:-Bavishi FertilityInstitute joined handswith DiamondInstitute for infertilityand menopause, NewJersey, USA for setting

of world class IVF centre inAhmedabad. The diamond Institute hasconstantly supported Bavishi FertilityInstitute on technology and training aswell as scientific and public awarenessprogrammes.


Awards & Milestones

Award Form IMA: Dr. Himanshu Bavishi is the first IVF specialist to get “Excellence in the Fieldof Medicine” award from Indian Medical Association, Gujarat State Branch for his pioneeringwork in the field of infertility

In 2008 live birth with vitrified frozen egghappened for the first time in India at BavishiFertility InstituteBavishi Fertility Institute proudly claimed first livebirth of India with frozen egg (Vitrified oocytes).Very few live births were recorded world over tillthat date. Now Bavishi Fertility Institute hassuccessfully delivered babies through frozen eggof patients, donor and even with testicular sperm.Bavishi Fertility Institute’s pioneering concept of“Egg Bank” is now well established.

Pioneered in surrogacy in indiaTo help infertile couples who cannot become parentswithout the help of surrogacy, Bavishi Fertility Institutepioneered Surrogacy treatment in India. Bavishi FertilityInstitute become first institute of India to treat Europeancouple for surrogacy in 1999. Dr. Himanshu Bavishi isfounder president of “Indian Society for Third PartyAssisted Reproduction”– INSTAR.

Bavishi Fertility institute received "socrates award - rose of Paracelsus" fromeurope Medical association on 3rd July 2017, at lucerne switzerland, at anevent organised by europe Business assembly.


PREFACE“A safe pregnancy and geniuschild do not just happen” but itis a collective effort ofconscious, well informed,actively involved parents andtheir medical service providers. In spite of rapid developments,science has not been able toproduce life. Bringing a newlife to this world is no less thana miracle. When you arebringing a new life to theworld, it is very very special foryou, your family, your nearones and dear ones, yoursociety, nation and the world.Pregnancy is the mostenjoyable phase in the life of awoman. Mood, atmosphereand attitude of the wholefamily changes. A lot ofpreparations are to be done forthe new arrival.Correct scientific informationin concise, easy to understandand utilizable formatempowers pregnant women.Correct and scientificknowledge on physical andemotional changes, commonsymptoms and remedies, idealnutrition, child development,proper ante and postnatal careand child birth is an essentialtool and helps a would bemother cope with the changesas they evelove in a pregnancy. The book is a compilation ofthe latest information ofmedical science and thewisdom of ancient sciences

like “Garbh Sanskar” with itsmodern relevance.Through the inclusions ofeasy-to-understand terms,accurate medical information,real-life scenarios of conditionsthat could occur duringpregnancy (and how to handlethem), this book givespregnant women the power tomaximize their chances ofhaving a successful pregnancy,delivery and ultimately, ahealthy baby.Bavishi Fertility Institute is apremiere fertility treatmentinstitute of India and theworld. We have vastexperience of treatingpregnancies, more importantlyhigh risk and preciouspregnancies. We value theimportance of safe journey ofpregnancy and child birth, andhave hence done the hardwork to help maximumcouples and families to fulfilltheir dream of a completefamily, safely and make theirjourney of Parenthoodenjoyable and fulfilling.“Your Miracle In Making”,published in four languages -English, Gujarati, Hindi andMarathi, is a book verymeticulously prepared for, the“to be parents”.This book gives you allinformation you need aboutyour pregnancy.

INDEX1. Pregnancy at a glance 172. Diagnosis of pregnancy 203. Pregnancy week by week 224. Food and nutrition in pregnancy 385. Antenatal visits 456. Blood tests and Ultrasound scans during pregnancy 487. High risk in pregnancy 558. Complications and warning signs in pregnancy 599. Health in pregnancy 6110. Precautions in pregnancy 6611. Choosing where to have a baby 7212. Feeling and bonding between mother and fetus 7413. Labour and birth 7714. Preparation for breast feeding 7815. Exercises in pregnancy 8416. Medicines in pregnancy 8817. Preparing for a new born baby 9018. Checklist for hospitalization 9219. Warning signs in new borns 9420. Pregnancy & working women 9621. Baby shower 10022. Garbh Sanskar 10223. Fatherhood 10624. Customs and beliefs 11025. Postnatal care 11426. Cord blood stem cell preservation 12027. Newborn screening 12128. Immunization Schedule 122


Chapter 01

Pregnancy at a glance

Whenever one thinks of pregnancy,fertilization is a basic need. Conceptionis the process that begins withfertilization of an egg with sperm andends with implantation of an embryo inmother's uterus.

natural conceptionA woman conceives around the timewhen she is ovulating, i.e. when egg hasbeen released from her one of theovaries.

During intercourse (sex) sperms areejaculated from a man's penis into awoman's vagina. In one ejaculation,there may be millions of sperm butmost of sperm leaks out with semen outof vagina but some starts to swim upthrough cervix. In an ovulating woman,

cervical fluid facilitates spermtransportation into fallopian tube.Fertilization takes place in fallopiantube.Within 4-6 days of fertilization, theembryo (fertilized egg) moves slowlydown through the fallopian tube touterus and it is already growing. Theembryo attaches itself to uterus, it iscalled implantation. Afterimplantation, the embryo – pregnancyproduces hormones which supportpregnancy. Hormonal release from anembryo prevents uterus lining(endometrial) from being shed. This isthe reason why a woman misses herperiod when she is pregnant.During pregnancy hormone levelschange.This increase in hormone level maycause following effects :-• You may have mood swings• Feel easily irritable• Feel nausea, vomiting• Heaviness in epigastrium (upperabdomen) / acidity• Uneasiness etc. But these effects become lessprominent, disappear or change slowly around 3 months of pregnancy.

Best time to get pregnantA woman is most likely to get pregnantif she has intercourse (sex) within 24hours of ovulation. Ovulation usuallytakes place at around 14th day of


normal regular 28 days of cycle. An egglives for about 12-24 hours after itsrelease. During which it should befertilized by a sperm. A sperm can liveup to 72 hours in a woman's body.

sperm will decide - a boy or a girlEvery cell of the body has 46chromosomes (tiny thread likesstructures carrying about 2000 genes).Sperm and egg have half number ofchromosomes (23 chromosomes each).After fertilization embryo has 46chromosomes, 23 from father and 23from mother. Female egg alwayscontains X chromosome, whereas malesperm can have either X chromosomeor Y chromosome. Hence, when egg &sperm meet, sperm decides a boy (XY)or a girl (XX).

a healthy pregnancy keepseverybody happyWhenever you start thinking about

pregnancy or trying for pregnancy, tryto be healthy from beginning evenbefore pregnancy and maintain yourhealth before, during and afterpregnancy.Remember that, it can take a year to bepregnant. It is a good idea to consult adoctor when you try for a pregnancy forevaluation of your health and optimizeyour nutrition. If you are trying from 1year or more and if you do not get resultthen consult your doctor soon to findout the reason for not conceiving.You may visit your doctor particularlyso,• If your age is more than 30 years• You have had any previous illness• Any operation in your pelvis• Any health issue with your husbandetc.There are few things to be taken care ofto help you to stay on healthy side.• Start changing your dietary habit andschedule. Include more healthy food inyour diet. Avoid eating outsideunhealthy and junk food.• Exercise: It is very important to controlyour weight before getting pregnant asit will help you to stay in shape duringpregnancy. Weight reduction can loweryour risk of miscarriage and has beenproven to help reduce pregnancy andlabor complications.• Educate your self about pregnancy,body changes during it, stages ofpregnancy and labour, delivery / birth,when to consult a doctor.• Talk to your doctor or relatives to getknowledge and their experience aboutpregnancy. Share their experience ofparenthood.• Visit your dentist before you get

pregnant for dental check up. Brushyour teeth daily.• Stop smoking and taking alcohol.• Ask your hubby to join you on newhabit change. Let him know aboutchanges you get, your emotions everytime and let him enjoy his fatherhoodtoo.• Develop habit of reading books andliterature that bounds good and calm toyour mind and soul. Avoid watchingviolent shows and movies. Develophabit of listening light music.• Take rest whenever you can. Even anap is refreshing.• Join a class of prenatal yoga orprenatal exercise.

• Avoid chemicals that could possiblyharm to your body which may bepresent at your work place, at yourhome or anywhere.• Whenever you visit medical orparamedical person, tell them that youare pregnant. This can prevent exposureto harmful tests and chemical.• Daily drink 6 to 8 glasses of water.• Add 300-500 calories a day whilepregnant.• Know about signs of premature labourand its warning signs to call doctor.• Take a breast feeding class to help andprepare your self for it.• Keep your bag ready to go to birthcenter or hospital.


Chapter 02

DIagnOSIS OF PregnancyThe beginning of pregnancy may bedetected in a number of different wayseither by medical testing or by withoutmedical testing.These are some symptoms that cansignify pregnancy which can mostwomen experience.• Like nausea, vomiting, excessivetiredness, fatigue.• Craving for certain food that normallynot considered as a favorite food.• Frequent urination.• Missed menstrual period.• There are some blood and urine testthat can detect pregnancy 12 days afterimplantation. Blood test is more accurate than urine• Blood test is Serum Beta HCG level. It is

most accurate. It may be done in serial.Home pregnancy test is urine test. • You can check your morning urinesample in strip. In that if you arepregnant then you get 2 lines.Ultrasonography - but it can be useful 3 - 4 weeks after fertilization.•It can detect small Gestational sac asearly as 4-5 weeks by transvaginalultrasound. •It can detect G.Sac (a bag of water inwhich the pregnancy develops) withYolk sac as early as 5 wks.•It can detect embryo as early as 5 wks 3days.• It can detect fetal heartbeat as early as6 wks.

The most common signs

and symptoms are


Chapter 03

Pregnancy WeeK By WeeK

In previous chapter you have gonethrough how you became pregnant andthen you have confirmed yourpregnancy.Now we are sure that there are fewthings in your mind that are:1) What is your current week/age ofpregnancy?2) How your baby may look like in thewomb today?3) How much your baby may weigh andin length at present stage ofpregnancy?Some of the common terminology:embryo: From conception to 8th weekFetus: From 9th week to till birth ofbabygestational age (Menstrual age):Starts from 1st day of your LMP (Last

menstrual period).Mostly used by doctors.Average gestational age at delivery is 40weeks.ovulatory age (Fertilization age):Starts from the day you conceive.Average ovulatory age at delivery is 38weeks.trimester: There are 3 trimester inpregnancy. Each trimester consists of 13weeks.lunar months: A pregnancy lasts anaverage of 10 lunar months (28 dayseach) hence 280 days in total.Due date calculation: Your doctor willalways calculate your due date from the1st day of your LMP. For instance 9months +7 days in your 1st day of LMP.The average length and weight of baby


varies from baby to baby and onepregnancy to other.umbilical cord: The umbilical cord is ababy's lifeline. It is the link between youand your baby. Blood circulates throughthe cord, carrying oxygen and food tothe baby and carrying waste away.Placenta: The placenta is attached tothe lining of the uterus and separatesyour baby's circulation from yourcirculation. In the placenta, oxygen andfood from your bloodstream pass intoyour baby's bloodstream and are carriedto your baby along the umbilical cord.Antibodies that give resistance toinfection pass to your baby in the sameway. Alcohol, nicotine and other drugscan also pass to your baby this way.amniotic sac: Inside the uterus, thebaby floats in a bag of fluid called theamniotic sac. Before or during labour,the sac or 'membranes' break and thefluid drains out. This is known as the'water’ bag leakage.

6 weeks PregnancyChanges in fetus: • From crown (top of the head) to rump(bottom of buttocks) your babymeasures 2-4 mm or 0.08-0.16 inch, thesize of small lentil.• Heart is size of poppy seed andbeating on its own.• Your baby has its own blood streamwith blood circulating already.• Within 5 months more than 100s ofbillions of neurons are formed in thebrain.• Embryos are 10,000 times larger thanegg.

Changes in you:• You may loose some weight due to noteating well and nausea.• Abdominal changes are not apparent.• The areolas darken to brownish circleof patches around the nipples.• Bluish vein may seen under the skin ofbreasts.• You may be prone to fatigue andnausea.

7 weeks PregnancyChanges In Fetus:• From crown to rump your babymeasures 4 - 5 mm or 0.16 - 0.20 inches,size of small raspberry.• Beating heart is seen.• Baby's intestine, heart chambers andbrain hemisphere are formed.• Eyes and nostrils are formed.• Small protruding buds are also seenthat develops in ears and limbs.• The skull is still transparent and brain isgrowing fast.

Changes in you:

• Weight gain is still less.• In many patient it may be lost due tonausea, vomiting and inadequate food.• You may have symptoms like nausea,vomiting, fatigue, indigestion, constipation etc.• Mucus plug (sticky discharge) is alsoestablished in cervix and it may come out from vagina. If it is notassociated with itching or foul smelling then it is normal (physiological).• You may have dreams and fantasiesabout your baby and these are true beginnings of your emotional bonding.

8 weeks PregnancyChanges in fetus:• From crown to rump your babymeasures 14-20 mm or 0.50-0.75 inches,size of pinto bean (type of Rajama).• Now your baby graduates fromembryo to fetus.• All main internal organs are present.• Baby has recognizable human facewith nostrils, lips & mouth with tongue. • This baby is covered with skin but is

still translucent.• Baby has started moving inside theuterus but you will not be able to feel it.• Toes & fingers begin to form. Paddleshaped feet & hands are present.• Baby's eyelid begins to form and untilit completes the eye will appear open.• Digestive tract is growing

The brain cells are developing.

Eyes and ears are becoming

noticeable, hands and feet are

emerging from developing

arms and legs.


continuously.• 10 Dental buds have formed in eachjaw.• Heart function is fully developed withpumping approximately 150/Beat per minute.• Umbilical cord is clearly visible.

Changes in you:• Uterus is size of a tennis ball.• Because of hormonal changes youmay have mood swing similar to premenstrual tension.• Your metabolic rate is increasing 10-25%.• Your uterus tightens, contracts andrelaxes throughout pregnancy but youmay not feel it.• You may have constipation.• You may have insomnia, nausea,vomiting.

9 weeks PregnancyChanges in fetus: • From crown to rump your babymeasures 22-30 mm or 1-1.25 inches, size of green olive.• Baby looks like tadpole and morehuman.• Hands and feet continue to growalong the fingers, toes and elbows.• Internal organs such as ovaries, testes,pancreas, intestine, gall bladder andanus have formed but we can not makeout external genitalia.

Changes in you:• Your waist line may start to thicken.• Your HCG level is at peak in this week.• Your first trimester's symptoms maycontinue.• Your belly's shape may change. You

may have increased vaginal discharge that is normal in pregnancy.• You may have metallic taste in yourmouth.

10 weeks PregnancyChanges in fetus:• From crown to rump your baby measures 31-42 mm or 1.25-1.75 inches.• Baby has started to put on weight.Your baby's weight is approx 5 gm or0.18 oz.• Prenatal test CVS (Chorionic VillousSampling) usually conducted from this week to 12th week.• You can come to know about manycongenital malformations that occur during embryonic period.• All vital organs have formed.• Tail has disappeared totally.• Finger and toes are no longer webbed.• Skeleton, bones are starting to form.• Rapid brain development is taking

place with almost 2,50,000 neurons being produced every minute.Changes in you:• You may or may not gain few kg.(kilogram) of weight by now, but you may lose weight due to nausea andvomiting.• Abdominal changes are still notapparent.• You may have spotting or brownishdischarge that is called implantation bleeding. If excessive, consult yourdoctor.• You may have tender breast, mildcramps in lower abdomen.

11 weeks PregnancyChanges in fetus:• From crown to rump your babymeasures 44 - 60 mm or 1.50 - 2.50inches, size of peanut.• Fetus weight is 8 gm or 0.3 oz.• Baby increases 30 fold and tripple inlength.

• Blood vessels in placenta aremultiplying to keep up with nutrientssupply to fetus.• External genital shows obviousdifferences but it would be morecomplete after 13 weeks.• Baby can open mouth and close hisfist, baby can suck thumb. Heartbeat is120-160/BPM.

Changes in you:• Some woman experience glowing skinwhile other suffer from acne.• Some feel changes like hair and nailgrowth and hair loss.• You have leg cramps that are mostcommon but it is not harmful. It is due to mineral and vitamin deficiency or itmay be due to your leg is not able to tolerate the weight of a pregnantuterus.• You may have mood swings also.

12 weeks PregnancyChanges in fetus:• From crown to rump your baby measures 60 mm or 2.50 inches, size of plum.• Fetus weight is 14 gm or 0.5 oz.• It is end of first trimester.• Baby is active, moving in the uterus.• Baby is swallowing amniotic fluid, can pass urine which constitutes amniotic fluid.• Baby has wrist, ankles, elbows, fingersand toes with nails and can make a fist.• Baby's head is quite large inproportion to body.• Baby is floating in amniotic fluid that isapproximately 100 ml.

Changes in you:


• Your risk of miscarriage dropssignificantly.• You may develop black line (dark) onyour abdomen called linea nigra which will fade after birth.• You may gain 10% of total pregnancyweight or you may lose also.• You may have frequency of urination,bleeding gums due to hormonal changes.• Now your uterus will grow up justabout the pelvic cavity so, you may have less pressure on your bladder.• Your breast size increases.

13 weeks PregnancyChanges in fetus:• From crown to rump your babymeasures 65-78 mm or 3 inches.• Fetus weight is 20 gm or 1 oz.

• Baby's vocal cord forms.• Baby is hiccupping now, so this willstrengthen diaphragm and prepare respiratory system for breathing.• Kidneys can make urine & bonemarrow is making white blood cells for fighting against infection after birth.• All the baby's organs, nerves, musclesare formed and now start to functiontogether.• Baby's eyelids are fused together andwill not reopen till 30 weeks to protectdeveloping eyes.

Changes in you:• You will feel better and less sick.• Your shoes are beginning to feel tight.• You may have chances of gettingurinary tract infection very frequently.

Your Miracle In Making30

So ensure good liquid intake.What to keeP in MinD DuringPregnancY:As your baby is totally dependent onyou for all its need, so you should eatproperly, rest enough and stay ashealthy as possible throughoutpregnancy.

About food1. Avoid fatty & greasy food, carbonateddrinks, junk food & processed meals.2. Eat slowly.3. Take healthy balanced diet & freshfood.4. Take plenty of water, juices and fiber food to avoid constipation.5. Take frequent small meals, 5-6 times per day, that relaxes your Stomach and maintain your sugar level rather thaneating full at a time.6. You may take all types of fruits anddry-fruits.7. Take high protein diet like sproutedmoong, black gram, rajma etc. and chikkies etc.8. You need additional 300 calories/dayduring pregnancy.9. Avoid junk food or outside food.10. Take biscuits or bhakhari beforerising in the morning.11. If you still feel nausea and vomitingyou can try a trick- Soak cucumber in water for 10 minutes and then have.

About Habits and hygiene1. Avoid lying flat on your back, trypropping yourself to avoid heartburn.2. Try to sleep in lateral positions.3. Remain stress free4. You can do yoga, walking, swimmingetc, if you don't have any problem.

5. You can listen soothing soft music orread inspiring books.6. If you want to do hair dye/hair color,you can do it, but you may not get proper result because of hormonalchanges. It is not harmful to fetus.7. Avoid smoking, tobacco chewing

throughout pregnancy.8. Remain hygienically clean and washyour hand with soap each and every time before you eat.9. Restrict tea and coffee intake.10. Avoid polluted air.11. You may feel the size of your clothhave changed gradually .12. Don't wear too tight cloths.13. Your entire blood circulation systemincreases during pregnancy, so you may feel dizziness, dehydration,headache, sweaty & flushed feeling. 14. You have to visit doctor regularly.15. If you have swelling on your legcontact your doctor and keep your leg elevated.16. If you have pain in abdomen, waterydischarge consults your doctor.17. You should check for checklist ofhospitalization.


Changes in you:• You may have gained weight approx.up to 4 kg.• You can feel your baby's movement for1st time after 20 - 22 wks and if it is your second pregnancy, you will feelearlier approx. at 16-18 week.• Your first trimester symptoms havealmost gone up at except you can have occasional nausea due to acidity.• At first you feel fluttering/bubbling orslight shifting movement.• Sometimes you will see a bump that isclearly hand/foot.• Now height of your uterus grown up tojust below the navel.

23-30 weeks PregnancyChanges in fetus:• Baby is now moving about vigorouslyand responds to touch and sound.• Baby is swallowing small amount of amniotic fluid and is passing urine in amniotic fluid.• Your baby may get hiccup and you can

feel it by a jerk.• Your baby also follows a pattern ofwaking and sleeping. And it may bedifferent from you.• Your baby's heartbeat can be heardthrough stethoscope now.• Your baby may also be covered byvernix, greasy substance that disappears after birth.• From 26 week, your baby has a chanceof survival, if it is born.• Bone marrow begins to make bloodcells.• Taste buds form on your baby`stongue.• Real hairs begins to grow on yourbaby`s head.• Lungs are formed but not working.• Baby`s reproductive organs begin toset their proper place.• At 26 week your baby's eyelids openfor 1st time. • Your baby is in size of 11 to 17 inch inlength and weight is up toapproximately 500 gms at 23 weeks to1.7 kg at 30 week.

Changes in you:• You have gained weight and it isapprox. 1 kg per month.• Height of your uterus grows up to justabove the level of navel.• You feel lots of movement of fetus atthis time.• You may have acidity problem asuterus is growing.• You have swelling in legs & hands, it iscommon in pregnancy but you have to check your B.P. (Blood pressure)• You may have stretch marks on yourtummy or thighs. Your breast size has increased.

14 weeks PregnancyChanges in fetus:• From crown to rump your babymeasures 78-85 mm or 3-4 inches.• Fetus weight is appro.20 gm or 1 oz.• Reproductive organs of the baby aredeveloped.• Thyroid gland begins its function.• Baby's skin is very thin, head hair andeyebrows are growing.• Bone marrow has begun to produceblood cells which were previously produced by yolk sac.• Now your baby is yawning, stretchingor wiggling her toes and fingers, butyou can not feel all these movement.

Changes in you:• Some woman has started to produce

colostrum or premilk.• Your all first trimester symptom mayend up or you feel better than earlier.• You can feel your uterus just above thepelvic region.

15-22 weeks PregnancyChanges in fetus:• Baby is growing faster than any othertime in their life.• Head and body are more inproportion.• The face becomes much moredefined and nails, eyebrows andeyelashes are beginning to grow.• Your baby has their own individualfingerprint, footprint, the finger nailsand toenails are growing and hand cangrip.• At 22 weeks your baby is covered invery fine soft hair called lanugo.• Muscle tissue and bone continue toform, creating more complete skeleton. • Skin begins to form.• Meconium develops in your baby`sintestinal tract. It is first bowelmovement.• Sucking motion with mouth isdeveloping.• More active baby and feel fluttering.• Baby is covered by fine, downy hairylanugos a greasy substance called vernix this protects the skin.• Eyebrows, eyelashes, fingernails,toenails, have formed. Your baby can scratch itself.• Baby can hear and swallow.• Size approx. 10 - 11cm (at 15 wks) to 27- 30 cm (at 22 wks), weightapproximately 100 (at 15 wks) - 500 (22wks) gm.

Week 22


31-36 weeks PregnancyChanges in fetus:• Baby is continuously growing.• Skin becomes smooth and lanugodisappears but vernix gets thickened.• Regular talking, reading and singing toyourself while you are pregnant will help you to bond with your babybefore birth.• Baby gains weight by half pound/week• Bones are fully formed but soft.• Baby’s kicks are very forceful.• As baby is growing very fast, baby hasless space to move around so you canfeel only stretching and wiggles likemovement at the end of 35 weeks.• Now baby can open and close eyesand sense changes in light.• Lungs are not fully formed butbreathing movement occurs.

• Baby`s body begins to store mineralsand vitamins.• Your baby measures 16-19 inches inlength and weight approximately 1.5 kgto 2.6 kg.

Changes in you:• Height of uterus reaching up to chestjust below the ribs.• You have discomfort in breathing, painaround lower ribs, swelling in legs and hands.• Some times you have stretch marks onyour abdomen and thighs.• You may have itching on yourabdomen due to stretching of skin.• You can feel tightening and relaxationof your uterus.• You have to go frequently forurination.

37-40 weeks PregnancyChanges in fetus:• From crown to rump your babymeasures approximately 19-21inches and weight approximately 2.8 kgto 3.5 kg.• Baby is considered full term.• Baby`s organs are ready to function ontheir own.• Your baby may turn into head downposition for birth.

Changes in you:• Swelling in leg may increase.• Frequency of urine is also increasing asyour baby's head is engaging in pelviccavity.• You may feel contraction andrelaxation of uterus.• You may have back pain.

Week 36


Chapter 04

FOOD & nUtrItIOn In PregnancyNutrition and pregnancy refers tonutritional intake and dietary planningbefore, during and after pregnancy.The expecting mom should be verycalm and peaceful, also focused onwhat they should do for a healthypregnancy. Eating healthy duringpregnancy will help your baby todevelop and grow and will help to keepyou fit and well. You don't need to goon a special diet but make sure that youeat a variety of different foods everydayin order to get right balance of nutrientsthat you and your baby need.You might feel more hungry thannormal but you do not need to "Eat fortwo" even if expecting twins or triplets.

gooD routine FooD ForvegetariansWhat should include in your daily foodto label it as balanced diet?1. Fruits and vegetables:

Theyprovidesvitamins,mineralsand fiberswhichhelps in

digestion and prevents constipation.Eat at least five portions of fresh, frozen,dried or juiced fruit and vegetableseach day, after washing them carefully.Better to eat raw or lightly cookedvegetables.2. Foods and beverages which are

rich in fat:This groupincludes alloils, ghee,saladdressings,cream,chocolates,biscuits,cake,

puddings and sugar containing drinks.You should eat only a small amount ofthese foods. As sugar contains onlycalories without providing nutrition tobody. Frequent consumption of suchfood may cause tooth decay and weightgain. Try to reduce or avoid food that ishigh in saturated fat and have foods richin unsaturated fat.3. rice, potatoes, bread and otherstarchy foods:

These foodtypescontain

carbohydrate which is satisfactory tostomach without containing too muchcalories. These are also importantsource of vitamins and fibers. Suchother foods are oats, maize, millet,sweet potatoes, pastas etc. such foodshould be main part of every meal.4. high Protein Diet:For this you can take Sprouted Mung,


Chana(BlackGram),Muth,Rajamaetc... atleast one

bowl per day.You can take any Kinds of Chhikies likeGound nut (Shing) chikkies, Dry fruitschikkies, Dalia's chikkies etc. preferablymade from jaggary rather than sugar.These foods are main source of proteins.One should eat moderate amount eachday. 5. Milk and dairy products:

Milk and itsproductslike buttermilk,paneer,andyoghurt

are important. They contain calciumand other nutrients needed by a baby.Whenever take milk, remove creamfrom it or use skimmed or low fatvariety milk. You can use low fat paneer,yogurt.6. healthy drinks and snacks duringpregnancy:

In additionto otherfood andfluids, drink8 to 10largeglasses (at

least 2-3 liters) of water a day. Arefreshing alternative is a glass ofchilled filtered water with a twist of limeor mint. There are some other healthy

drinks that can be tried i.e. coconutwater, lime juice, skimmed milk, bananashake.It is best to prepare milk shakes andjuices at home and drink themimmediately. This reduces risk of anyspoiling or contamination. Also becareful while buying drinks fromroadside vendors as it is difficult tojudge its hygiene and freshness.There are some tasty and healthy snacksthat you would like to take duringpregnancy i.e. grilled paneer tikka (lowfat paneer), fruit and vegetablebhelpuri, dhokla or khandvi , sweetpotato chat, steamed or sautéed corn orcorn chat, upma, mixed vegetable idly,batata poha, Khakhara, shing- chana,Sev- mamra, popcorn etc.Try to limit or decrease intake of deeplyfried or more ghee, butter rich snacks. Itis better to use plant oils rather thananimal fat that are high in saturated fat.Be guided by your appetite but bewareof emotional eating that could makeyou over eat at a time.

iMPortant eleMents1. requirement of folic acid duringpregnancy:It is recommended to take daily folicacid supplement of 400 mcg startedbefore pregnancy (prenatally) and for atleast first 12 weeks of pregnancy. It isrequired to protect your unborn babyagainst developing neural tube defects,such as spina bifida.Following are some good sources offolic acid (foliate):• Green leafy vegetables like spinach(palak), fenugreek leaves (methi),corianders (green dhania), radish


(mulo), mustard greens, mint (phudina),lettuce, etc.• Pulses like Bengal gram (chana), soyabeans, chick peas ( vatana), kidneybeans (Rajama) etc. • Vegetables like beetroot, peas,cabbage, French beans (fansi), lady'sfinger (bhinda), bottle guard (dudhi),carrot (gajar), corn (makai) etc.• Fruits like pomegranate (dadam),guava (jamfal), oranges, sweet lime(mosambi), strawberry etc. • Dry fruits and nuts like almonds,peanuts (moongfali), walnuts etc.

2. other vitamins and mineral:A. Vitamin D:Vitamin D is needed to keep boneshealthy and to provide baby enoughvitamin D. Vitamin D regulates amountof calcium and phosphate in bodywhich keep bones and teeth healthy.Many vegetarian mothers may havedeficiency of vitamin D. The best sourceof vitamin D is sunlight. The time ofexposure to sun light to get vitamin D isdifferent for different person as itdepends on skin type, time of the dayand a year.B. Iron:Deficiency of iron lead to anemia (lowhemoglobin) which causes weaknessand easily fatigability. Food rich in ironincludes green leafy vegetables,jaggery, beetroot, Carrots, Millets, dryfruits (Figs, Black kismis) dates, etc. it isalso supplied in form of tablets andsyrups throughout pregnancy by adoctor.C. Vitamin C:It helps to absorb iron. Citrus fruits andvegetables like orange, sweet lime,

amala, broccoli, potatoes, tomatos, andsome pure fruit juices are good sourceof vitamin C.D. Calcium:Calcium is needed for making baby'sbones and teeth. Milk and milkproducts, fruits like banana, dry fruit likefig and apricot, almond etc are goodsource of calcium. It is also supplied intablet form by a doctor during and afterpregnancy. E. Omega 3 fatty acid:

BaD FooDsFood to be avoided or restricted duringpregnancy :-1. caffeine: Caffeine is naturally presentin lots of food like coffee, tea,chocolates etc. it is also added in somesoft drinks and energy drinks, certaincold and flu remedies. Higher level ofcaffeine may cause miscarriage and lowbirth weight baby. You don't need to cutcaffeine out completely but, its useshould not be more than 200 mg perday. Caffeine contents in foods and drinks :-• 1 mug of tea - 75 mg • 1 mug of filter coffee - 140 mg• 1 mug of instant coffee - 100 mg• 1 can of cola - 40 mg• 50 gm bar of plain chocolate - up to 50mgSo you can calculate your caffeineintake accordingly.2. smoking:Each cigarette contain about more than4000 chemicals. Every cigarette yousmoke harms your baby in your womb,by restricting necessary oxygen supplyto your baby. So your baby's heart hasto beat harder, every time you smoke.

So it is a must to stop smoking. Bothyou and your baby will be benefittedimmediately by clearing carbonmonoxide (poisonous gas) from bodyand bringing oxygen level normal.Passive SmokingWhat is passive smoking?Passive smoking is the inhalation ofsmoke, called second hand smoke (SHS)or environmental tobacco smoke bypersons other than intended activesmoker.Passive smoking increased the risk ofstill birth by almost one-quarter (23 percent) and was linked to a 13 per centincreased risk of congenital birthdefects. The findings underline theimportance of discouraging expectantfathers from smoking around theirpregnant partners and warning women

of the potential dangers ofsecond-hand smoke bothpre-conception and duringpregnancy.The researchers say fatherswho smoke should be moreaware of the danger theypose to their unborn childand that since it currentlyremains unclear when theeffects of the second-handsmoke begins it is importantto protect women frompassive smoking both beforeand during pregnancy.3. alcohol:Whenever a mother drinks,alcohol passes from her bloodto baby through placenta.Baby's liver is the last organ todevelop fully and does notmature until the latter half ofthe pregnancy. So your baby

can not accept or digest alcohol like youcan. In early days of pregnancy toomuch alcohol intake can result inmiscarriage. Excessive intake of alcoholduring pregnancy leads to some foetalabnormalities like restricted growth,facial abnormalities, learning andbehavioral disorders. 4. Medications:It is preferred that whenever you aretrying for the pregnancy or alreadypregnant, talk to your doctor regardingeach medication that you are takingregularly. Your doctor will decidewhether it is required to change it orstop it. Even some pain killers are alsoharmful to your baby's health but someare safe. So do not take any medicinewithout asking your doctor.


Chapter 05

antenatal VISItSPregnancy, labor & birth of a child areimportant milestones in a couple's life.Regular medical care, understandingthe unknown events during pregnancycan make child birth an extremelyenriching and joyful event.Women's health, behavior, diet, habitsand drug or illness affects the baby'sdevelopment, hence you should takegood care of your health and mostimportant is to go for regular checkupwith your doctor.Minimum visits during pregnancy forrural non affording patients• At least 3 visits during wholepregnancy.> 1st visit: before 20 weeks (before 5months)> 2nd visit: 20-30 weeks (between 5-7months)> 3rd visit: 34-37 weeks (around 8-9month)in regular patients it should be likethis:• Routine schedule:> Up to 13 weeks: every 15-20 days> 13 to 28 weeks: every 4 weeks> 29 to 36 weeks: every 15 days > Thereafter: weekly• In high risk pregnancy:> 1st trimester up to 13 weeks: every 15day or early whenever required> 14-26 weeks: every 4 weeks> 26-34 weeks: Every 15 days or earlierwhenever required according tosonography finding or high risk factor> 34 weeks onwards: weekly

What shoulD Be Done in eachanD everY visit?1st visit: It should be after your missedperiod.• Check for weight, Blood Pressure,pulse.• Confirmation of pregnancy by urinetest or blood test or by sonography.• In sonography see for - Presence of pregnancy- Health of pregnancy- Number of pregnancy- Location of pregnancy (intra or extra uterine pregnancy)- GS (a bag of water in which pregnancy develops)- YS (Yolk Sac)- Fetal pole and Fetal heart beatIt should be done by only TVS (internalsonography).• Give folic acid supplementation. Givesymptomatic treatment.• Counselling about good health andnutrition2nd visit: 6-7 WEEKS• Check weight, BP and physicalexamination.• In sonography see for GS, YS, fetalnumber and shape, heartbeat, fetalpole, size & chorionicity.• Advice for same medicines like folicacid, progesterone supplement ifrequired and symptomatic treatment.• Counselling about diet, health,travelling.• Reassurance for pregnancy symptoms.• Basic blood test for antenatal profile-


Hb, Sugar, Blood Group, HIV, HBsAg,Thalesemia screening.• Give appointment for next visit.3rd visit: 9-10 WEEKS• Check weight, B.P. (blood pressure) andphysical examination.• In sonography see for GS, YS, shape,heartbeat, fetal pole, size and chorionicity.• Advice for same medicines like folicacid, progesterone supplement if required and symptomatic treatment.• In case of high risk pregnancy give monitoring chart for blood pressure incase of hyper tension, sugar chart forDiabetes Mellitus/Gestational diabetesmellitus (GDM).• Counselling about diet, health,travelling.• Reassurance for pregnancy symptoms.• Prescribe appropriate medicine.• Follow up date for next visit after 15-20days4th visit: 11-13 WEEKS• Check weight, B.P. and physicalexamination.• In Aneuploidy scan sonography (NTscan- scan for markers of certain chromosomal anomalies) to detectearliest abnormalities in fetus.• Blood test like double marker forscreening of Down's syndrome andother genetic syndrome.• niPt (non invasive pre natal testing) -It is screening blood test to rule outhigh risk of fetus for geneticchromosomal abnormality in high riskcases.• It is done between 9 weeks to 20weeks of pregnancy.• It is more sensitive (99%) than othernon invasive tests (double marker, triple

marker). Because it is done from foetalDNA (approximately 10%) present inmaternal blood. There is no risk ofmiscarriage due to procedures ascompared to invasive procedures(aminocentesis and chorion biopsy etc).• For this test, maternal blood iscollected by special kit, then fetal DNAis seperated from the sample and test isdone from this fetal DNA.• OS tightening if required in high riskpregnancy with Bad obstetric history (recurrent pregnancy loss) or in multiplepregnancies.• CVS (Chorionic villous sampling) incase of prior genetic disease or significant fetal history of geneticdisease or higher risk factor in present pregnancy.• Continue same medicine. After 13weeks add Iron, calcium, uterinerelaxant if advised and protein powdersupplementation.• Tetanus Vaccine 1st dose.5th visit: 16-18 WEEKS• Check weight, B.P. and physicalexamination.• In sonography see for Fetal growth,heart beat, placenta location, cervicallength, liquor.• Blood test for hemoglobin, sugar level,triple marker that is screening test forDown's syndrome and other geneticsyndromes.• Amniocentesis if there is high risk forfetus or any Family history of genetic disease, previous sibling affected withgenetic disease.• In pregnancy with Hypertension -Blood Pressure monitoring chart• In Pregnancy with Diabetes-Sugarchart, Diabetic diet etc.

• In pregnancy with Thyroid disease-recheck thyroid hormone level andmedicine accordingly• In medicines continue Iron, calcium,uterine relaxant and protein powder supplementation.• Counselling for proper diet, nutrition,health• TT Vaccine if not given previously.6th visit: 20-22 WEEKS• Check weight, B.P. and physicalexamination.• Generally it is period of 3D-4Danomaly scan intended to detect anomalies in fetus, fetus echo etc. andcervical length, uterine doppler.• In pregnancy with Hypertension -Blood Pressure monitoring chart• In Pregnancy with Diabetes-Sugarchart, Diabetic diet etc.• In pregnancy with Thyroid disease-recheck thyroid hormone level andmedicine accordingly• Continue same medicine.• Counselling for proper diet, nutrition,health.• Counselling about stem cellspreservation (deatils in later chapter).• Counselling about where to deliver.• Tetanus Vaccine 2nd dose.7th visit: 26-28 WEEKS• Check weight, B.P. and physical

examination.• Look for growth of fetus, cervicallength, placenta, liquor, dopplerscreening.• Same Blood pressure chart, Sugarchart in respected patient.• Counselling about nutrition, health.• Inj. Steroids for fetal lung maturity.8th visit: 30-32 WEEKS• Check weight, B.P. and physicalexamination.• Look for growth of fetus, cervicallength, placenta, liquor, dopplerscreening.• Blood test like hemoglobin, sugar test.• HBA1C (average sugar level of 3months), thyroid profile in high riskpatient.• Inj. Anti-D in case of Rh. negative.• Same Blood pressure chart, Sugarchart in respected patient.• Continue same medicine.• Counselling about nutrition, health.9th visit: 34-36 WEEKS• Check weight, B.P. and physicalexamination.• Look for growth of fetus, cervicallength, placenta, liquor, doppler screening.• Same Blood pressure chart, Sugarchart in respected patient.• Continue same medicine.


Chapter 06

BlOOD teStS anD UltraSOUnD

ScanS DUrIng PregnancyWhen the urine pregnancy test ispositive, it's just the beginning of thetests and scans you will be offeredduring your pregnancy.During your pregnancy, you'll beoffered a range of tests, including bloodtests and ultrasound baby scans. Thesetests are designed to help make yourpregnancy safer, to check and assess thedevelopment and wellbeing of you andyour baby, or to screen for particularconditions. Weight and heightYou'll be weighed at your bookingappointment, & then regularly duringyour visits. Your height and weight willbe measured so that your BMI (bodymass index) can be calculated. Mostwomen gain on an average 10 - 12.5 kgin pregnancy, most of it after they are20 weeks pregnant. Much of the extraweight is due to the baby growing, butyour body also stores fat for makingbreast milk after the birth.UrineYou'll be asked to give a urine sample atyour pregnancy checkups. Your urine ischecked for several things, includingprotein or albumin. If this is found inyour urine, it may mean that you havean infection that needs to be treated. Itmay also be a sign of pre-eclampsia.Pre-eclampsia affects 10% ofpregnancies, and can be life threatening

if left untreated. It can cause thepregnant woman to have fits, and affectthe baby's growth. Blood pressureYour blood pressure will be measured atevery antenatal visit. A rise in bloodpressure later in pregnancy could be asign of pregnancy-inducedhypertension. It's very common for yourblood pressure to be lower in themiddle of your pregnancy than at othertimes. This isn't a problem, but it maymake you feel light-headed if you getup quickly.Blood testsAs part of your antenatal care you'll beoffered several blood tests. Some areadvised to all women, and some areadvised only if you might be at risk of aparticular infection or inheritedcondition. All these tests are done tomake your pregnancy safer or to checkthat the baby is healthy.Below is an outline of all the tests thatmight be advised. Blood groupIt is must to know your blood groupwhenever you become pregnant.AnemiaA full blood count, includinghemoglobin and to check that you arenot anemic. Anemia makes you tiredand less able to cope with loss of bloodwhen you give birth or face any


bleeding episode. If tests show thatyou're anemic, you'll be given higherthen usual dose of iron and folic acid. InfectionsYou may advised tests for :-• Susceptibility to rubella (Germanmeasles): If you get rubella in earlypregnancy, it can seriously damage yourunborn baby. • Syphilis: You may be tested for thissexually transmitted infectionbecause it can lead to miscarriage andstillbirth if left untreated. Hepatitis B: This virus can cause seriousliver disease, and it may infect yourbaby if you're a carrier or you're infectedduring pregnancy. Your baby won'tusually be ill but has a high chance ofdeveloping long-term infection andserious liver disease later in life. Yourbaby can be immunized at birth toprevent infection. If you have hepatitisB, you may be referred to a specialist.

• Hepatitis C: This virus can cause seriousliver disease and there is a small risk itwill pass on to your baby if you areinfected. It can't be prevented atpresent. If you're infected, you'll bereferred to a specialist, and your babycan be tested after it's born. • HIV (human immunodeficiency virus):This is the virus that causes AIDS. HIVinfection can be passed on to a babyduring pregnancy, at delivery or afterbirth by breast feeding. As part of yourroutine antenatal care, you'll be offereda confidential test for HIV infection. Ifyou're HIV positive, both you and yourbaby can have treatment and care thatreduces the risk of your baby becominginfected.Thyroid profileThyroid hormone levels are checked todetect any overt or subclinicalhypothyroidism, which can affect thebaby if not corrected.

Another blood test is offered at around28 to 30 weeks to recheck hemoglobin.Gestational diabetes screeningYou will also be screened for gestationaldiabetes between 26 and 28 weeks ofpregnancy with a glucose screeningtest. It can be HBA1C or GTT.HBA1C is the test that tells us youraverage sugar level of 3 months.The GCT test is done in a clinic ormedical laboratory and you will need todrink a sweet glucose drink, wait onehour and then have a blood test. If yourtest shows that you may be at risk ofhaving high sugar level you will beasked to take a Glucose Tolerance Test(GTT). Many women who have apositive result will not have gestationaldiabetes. Women with risk factors for diabetesmay be offered the GTT first. For thistest you will need to miss breakfast andthen have a blood test before having a

glucose drink. You will then have bloodtests at one hour and two hours afteryou have had the drink. If you testpositive for gestational diabetes you willbe given advice on how to manage yourpregnancy to keep you and your babyhealthy and you will be referred to anendocrinologist and diabetes specialistfor advice. UltrasoundsWomen are offered three to fourultrasounds during a normal pregnancybut some may require more for specificreasons. The ultrasounds that areoffered to all pregnant women are: First trimester ultrasoundA scan early in your pregnancy to checkfor • Presence and diagnosis of pregnancy• Fetal heartbeat • Number of babiesRepeat scans may be done dependingon the possibility of a miscarriage or


complications, or if you have a history ofmiscarriage.11-13 wks Aneuploidy scan (Nuchaltranslucency scan)The Nuchal translucency screening isdone between 11 and 13 weeks ofpregnancy. The scan is primarily ascreening test for Down syndrome andother chromosomal conditions, thoughthe sonographer will also take somemeasurements and checks your baby.The ultrasound is used to measure thethickness of the layer of fluid on theback of your baby's neck. Thismeasurement is then combined withthe result of a blood test which is donebetween 11 and 13 weeks and otherfactors such as your age, weight andnumber of weeks of pregnancy toprovide an individual risk assessment. This result tells you if your baby has alow or high risk of Down syndrome. Ifyou are considered high risk you will beoffered genetic counseling to discussyour options.3D-4D Anomaly ScanThis is a detailed ultrasound performedbetween 18 and 20 weeks of pregnancywhich screens for structural or physicalabnormalities in the brain, heart, spineand other important organs. You may also be offered other scans formedical reasons Cardiac ultrasound (Fetal echo)If you have diabetes, a family history ofheart abnormalities, or a high Nuchaltranslucency thickness, a cardiac scan(fetal echo) is sometimes performedaround 22 to 24 weeks. A detailedexamination of your baby's heart andconnecting blood vessels is performedby an experienced sonographer with

specific expertise in this area.Third trimester ultrasound (Growthmonitoring)If you have had complications inprevious pregnancies or havedeveloped a problem during thiscurrent pregnancy, you may be offeredother scans in your third trimester. Ifyour placenta was found to be low atthe time of the anomaly scansometimes a check is recommendedaround 32 weeks. If you havegestational diabetes, pre-eclampsia orare pregnant with more than one babyyou may be offered additional scans. Chorionic Villous Sampling (CVS)If earlier screening suggests that yourbaby has a high risk of geneticabnormalities, you may be offered achorionic villous sampling (CVS). A CVStakes a part of the placental tissue. Thisis done while the tester is using anultrasound to see your placenta. Thetest can be performed between the10th and 14th weeks of pregnancy andcarries a small risk of miscarriage. AmniocentesisYou may also be offered anamniocentesis if a previous screeningtest shows that your baby has a highrisk of some genetic disorders. Anamniocentesis involves taking a sampleof amniotic fluid (fluid around yourbaby) under sonography guidance andis usually performed between the 15thand 18th weeks of pregnancy. The testwill give you almost 100 per centcertainty. This test carries a small risk ofmiscarriage. There is less risk formiscarriage with amniocentesis ascompared to chorionic villous sampling.


Chapter 07

HIgH rISK PregnancyWhenever there is increased risk toeither mother or baby or both it is highrisk pregnancy.Risk factors for mother or baby may beexisting before pregnancy or maydevelop during pregnancy. It isnecessary to know all this factors so thatpregnancy and delivery can bemanaged properly and both motherand baby can be taken care off. In India, higher rates of maternal andfoetal mortality are due to inability todiagnose them in early stages, whichrequires more attention.risk Factors:A. Maternal factor:1. Mother's height less than 1.5 meters[5 feet].2. Mother's weight less than 45.5 kgs[100 pounds] 3. Obesity.4. Mother's age less than 20 years or 5. Mother's age more than 35 years.6. Previous delivery by caesareansection.7. Medical disorder existing before orduring pregnancy like • High blood pressure• Diabetes mellitus• Severe anemia• Heart attack• Epilepsy• Psychiatric disorder• Kidney disorder• Heart valve problem• Asthma• Rheumatoid arthritis

• Lupus etc.8. Drug use, alcohol or smokingaddiction before or during pregnancy, medications like antidepressant,anticonvulsant drugs. 9. Mother having Rh negative bloodgroup.10. Problem in previous pregnancy like• Preterm labour• High blood pressure with edema• Convulsions• Retained placenta or post partumhemorrhage11. Infectious disease during pregnancylike• HIV• Hepatitis c• Syphilis• Toxoplasmosis• Chicken pox12. Breech presentation at full term inprimi gravida (1st pregnancy)13. Placenta previa (low placentacovering internal os)B. Factors related to Fetus:1. Possibility of congenital anomaly inultra sound examination.2. Fetal growth restriction or possibilityof low birth weight. 3. Multiple pregnancy (twins, triplets, ormore).4. Past history of preterm delivery orfoetal death in previous pregnancy.These above mentioned factors may beharmful to mother or baby or both. Soin such cases, proper antenatal, intranatal and post natal care of a mother

56

and baby by a doctor [obstetrician andgynecologist] and his experienced teamis must. Every high risk pregnancyshould be monitored and delivered at atertiary center, well backed up with alltechnologies and NICU [neonatalintensive care unit]. Any maternal orneonatal complication can be takencare off and treated efficiently at suchplaces.In many high risk pregnancies related toneonatal causes, it may be easy todeliver mother at peripheral centre but,may be difficult to deal with new born.When it may require high quality andcomplicated immediate treatmentwhich may not be available or possibleat delivery centre. In certain caseseverything is smooth and normal butnew born may develop certainunexplained complications immediatelyafter birth and parent may have to rushto tertiary centre for NICU but new bornmay not permit that much time.Immediate [initial 5 minutes afterdelivery] is the most critical period for anew born and is the time to interfere forsurvival of baby.

If we analyze this situation, it is clearlynecessary that it is better to transferbaby to well occupied experiencedcentre when it is in uterus [in uterotransport]. If baby is reached to suchcentre before delivery, it can be easilytreated there after delivery.If the pregnancy is high risk and it islikely that, baby may need extra careand treatment. It is advisable toconduct such delivery at good,experienced and well equipped centerswhere mother and baby both can betaken care of.C. IVF pregnancy itself is a high riskpregnancy:There are so many unexplained factorswhich might have caused infertility maycontribute to high risk pregnancy i.e.• Age• Obesity• Diabetes• Hypertension• Previous major abdominal/pelvicsurgeryIt is a difficult to get pregnancy andhence any loss is much more important!

your miracle in making

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