Further information: Obstetrics and gynaecology
Obstetrics (from the Latin obstare , "to stand by") is the surgical specialty dealing with the care of women and their children during pregnancy, childbirth and postnatal. Midwifery is the non-medical equivalent. Veterinary obstetrics is the same concept for veterinary medicine.
Antenatal care
In obstetric practice, an obstetrician or midwife sees a pregnant woman on a regular basis to check the progress of the pregnancy, to verify the absence of ex-novo disease, to monitor the state of preexisting disease and its possible effect on the ongoing pregnancy. A woman's schedule of antenatal appointment varies according to the presence of risk factors, such as diabetes, and local resources.
Some of the clinically and statistically more important risk factors that must be systematically excluded, especially in advancing pregnancy, are pre-eclampsia, abnormal placentation, abnormal fetal presentation and intrauterine growth restriction. For example, to identify pre-eclampsia, blood-pressure and albuminuria (level of urine protein) are checked at every opportunity.
Placenta praevia must be excluded (PP = low lying placenta that, at least partially, obstructs the birth canal and therefore warrants elective caesarean delivery); this can only be achieved with the use of an ultrasound scan. However, early placenta praevia is not alarming; this is because as the uterus grows along the pregnancy, the placenta may still move away. A placenta praevia is of clinical significance as from the 28th week of gestation. The current management includes a caesarean section. The type of caesarean section is determined by the position (anterior or posterior) of the placenta.
In late pregnancy fetal presentation must be established: cephalic presentation (head first) is the norm but the fetus may present feet-first or buttocks-first (breech), side-on (transverse), or at an angle (oblique presentation).
Intrauterine growth restriction is a general designation where the fetus is smaller than expected when compared to its gestational age (in this case, fetal growth parameters show a tendency to drop off from the 50th percentile eventually falling below the 10th percentile, when plotted on a fetal growth chart). Causes can be intrinsic (to the fetus) or extrinsic (maternal or placental problems).
Maternal Change
Cardiovascular
The woman is the sole provider of nourishment for the embryo and later, the fetus, and so her plasma and blood volume slowly increase by 40-50% over the course of the pregnancy to accommodate the changes. This results in overall vasodilation, an increase in heart rate (15 beats/min more than usual), stroke volume, and cardiac output. Cardiac output increases by about 50%, mostly during the first trimester. The systemic vascular resistance also drops due to the smooth muscle relaxation caused by elevated progesterone, leading to a fall in blood pressure. Diastolic blood pressure consequently decreases between 12–26 weeks, and increases again to pre-pregnancy levels by 36 weeks. If the blood pressure becomes abnormally high, the woman should be investigated for pre-eclampsia and other causes of hypertension.
Endocrine
Pregnant women experience adjustments in their endocrine system. These adjustments include an increase in her estrogen levels; which is mainly produced by the placenta and is associated with fetal well–being. Women also experience increased human chorionic gonadotropin (β-hCG); which is produced by the placenta. This maintains progesterone production by the corpus luteum. Additionally, human placental lactogen (hPL) is produced by the placenta, ensuring nutrient supply to the fetus. This also causes lipolysis and is an insulin antagonist, which is a diabetogenic effect.
Additionally, there is increased prolactin, increased alkaline phosphatase, and increased progesterone production, first by corpus luteum and later by the placenta, whose main course of action is to relax smooth muscle.
Gastrointestinal
During pregnancy, woman can experience nausea and vomiting (morning sickness); which may be due to elevated B-hCG and should resolve by 14 to 16 weeks. Additionally, there is prolonged gastric empty time, decreased gastroesophageal sphincter tone, which can lead to acid reflux, and decreased colonic motility, which leads to increased water absorption and constipation.
Hematology
During pregnancy the plasma volume increases by 50% and the red blood cell volume increases only by 20-30%. Consequently, the hematocrit decreases on lab value, however this is not a true decrease in hematocrit, but rather due to the dilution. The white blood cell count increases and may peak at over 20 mg/mL in stressful conditions. Conversely, there is a decrease in platelet concentration to a minimal normal values of 100-150 mil/mL.
A pregnant woman will also become hypercoagulable, leading to increased risk for developing blood clots and embolisms, due to increased liver production of coagulation factors, mainly fibrinogen and factor VIII (this hypercoagulable state along with the decreased ambulation causes an increased risk of both DVT and PE). Women are at highest risk for developing clots, or thrombi, during the weeks following labor. Clots usually develop in the left leg or the left iliac venous system. The left side is most afflicted because the left iliac vein is crossed by the right iliac artery. The increased flow in the right iliac artery after birth compresses the left iliac vein leading to an increased risk for thrombosis (clotting) which is exacerbated by the aforementioned lack of ambulation following delivery. Both underlying thrombophilia and cesarean section can further increase these risks.
Edema, or swelling, of the feet is common during pregnancy, partly because the enlarging uterus compresses veins and lymphatic drainage from the legs.
Metabolism
During pregnancy, both protein metabolism and carbohydrate metabolism are affected. One kilogram of extra protein is deposited, with half going to the fetus and placenta, and another half going to uterine contractile proteins, breast glandular tissue, plasma protein, and hemoglobin.
Neurophysiologic
During pregnancy, the woman undergoes many physiological changes, which are entirely normal, including cardiovascular, hematologic, metabolic, renal and respiratory changes that become very important in the event of complications. The body must change its physiological and homeostatic mechanisms in pregnancy to ensure the fetus is provided for. Increases in blood sugar, breathing and cardiac output are all required. Levels of progesterone and oestrogens rise continually throughout pregnancy, suppressing the hypothalamic axis and subsequently the menstrual cycle. The woman and the placenta also produce many hormones.
Prolactin levels increase due to maternal Pituitary gland enlargement by 50%. This mediates a change in the structure of the Mammary gland from ductal to lobular-alveolar. Parathyroid hormone is increased due to increases of calcium uptake in the gut and reabsorption by the kidney. Adrenal hormones such as cortisol and aldosterone also increase.
Placental lactogen is produced by the placenta and stimulates lipolysis and fatty acid metabolism by the woman, conserving blood glucose for use by the fetus. It can also decrease maternal tissue sensitivity to insulin, resulting in gestational diabetes
Nutrition
Main article: Nutrition and pregnancyNutritionally, pregnant women require a caloric increase caloric of 300 kcal/day and an increase in protein to 70 or 75 g/day. There is also an increased folate requirement from 0.4 to 0.8 mg/day (important in preventing neural tube defects). On average, a weight gain of 20 to 30 lb (9.1 to 14 kg) is experienced.
All patients are advised to take prenatal vitamins to compensate for the increased nutritional requirements. The use of Omega 3 fatty acids supports mental and visual development of infants. Choline supplementation of research mammals supports mental development that lasts throughout life.
Renal
A pregnant woman may experience an increase in kidney and ureter size. There is also an increase in the glomerular filtration rate (GFR) by 50%, which subsides around 20 weeks postpartum. Plasma sodium does not change because this is offset by the increase in GFR. Additionally, there is decreased blood urea nitrogen (BUN) and creatinine, and glucosuria (due to saturated tubular reabsorption), persistent glucosuria may suggest gestational diabetes, and increased renin-angiotensin system, causing increased aldosterone levels.
Pulmonary
Changes in pulmonary activity for pregnant woman can include increased tidal volume (30-40%), decreased total lung capacity (TLC) by 5% due to elevation of diaphragm from uteral compression, decreased expiratory reserve volume, and increased minute ventilation (30-40%) which causes a decrease in PaCO2 and a compensated respiratory alkalosis
All of these changes can contribute to the dyspnea (shortness of breath) that a pregnant woman may experience.
Other
Other conditions that can be encountered include:
- Lower back pain due to a shift in gravity
- Increased estrogen can cause spider angiomata and palmar erythema
- Increase melanocyte-stimulating hormone (M
Lquid Prenatal Vitamins
Prenatal Vitamins. Prenatal vitamins in an easy-to-take liquid absorbs faster than ... Allergy Relief Antioxidants Arthritis Treatment. Beauty Products
Buy Prenatal Multivitamins products at discount prices from The ...
Homeopathics Allergy Support Herbs Arnica ... Prenatal Multivitamins ... © 2009 The Vitamin Shoppe. All Rights Reserved. The products ...
Prenatal vitamins: Give your baby the best start - MayoClinic.com
Prenatal vitamins are an important part of pregnancy nutrition. Here's why you need them, when ... Allergy medications during pregnancy: Are they safe? Headaches during pregnancy: What ...
Vitamins (Multiple/Prenatal) ; Seattle Washington WA
Most prenatal vitamins contain greater amounts of folic acid, iron, and calcium than standard ... If you have a life-threatening allergy, wear allergy identification at all times.
OhioHealth - Prenatal vitamins: Give your baby the best start
Taking prenatal vitamins before conception is the best way to help prevent neural tube defects. ... Allergy medications during pregnancy: Are they safe?
Prenatal vitamins: Give your baby the best start - MayoClinic.com
Taking prenatal vitamins before conception is the best way to help prevent neural tube defects. ... Allergy medications during pregnancy: Are they safe? Headaches during pregnancy: What ...
Prenatal Vitamin Side Effects
Prenatal Vitamin Side Effects Specially formulated multivitamins ... seek immediate medical attention, as the allergy may be due to any of the ingredients in the prenatal vitamins.
Pregnancy and prenatal vitamins
What are prenatal vitamins? For a mother's health, and the health of her baby, she ... Good Health in a Bad Economy | The Truth About Healthy Teeth | Allergy Survival Guide | Vitamins ...
PharmDaily.com | Iodine in Prenatal Vitamins Varies Widely
WEDNESDAY, Feb. 25 (HealthDay News) -- Most prenatal vitamins marketed in the United States don ... Allergy | Alt Med | Arthritis / Bones / Joints | Blood Pressure | Cancer | Cosmetic | ...
Prenatal Vitamins for Women.
Prenatal Vitamins for Women. ... Allergy & Sinus Antifungal Program Antioxidants Arthritis & Gout Asthma & Breathing