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Questionnaire for Pregnancy Care Programme
Q:Age of Mother: 30/35 years very late to conceive (Either for first time or subsequent pregnancy)?
A: No – upto 35 years of Maternal age is fine though fertility peak is between 22 to 28 years of age.
Q:What is the ideal period spacing between two pregnancies?
A: Minimum of two years to a maximum of 4 to 5 years is ideal spacing.
Q:Is it necessary to undergo medical examination (for both partners) before planning pregnancy?
A: It is ideal if both partners undergo clinical examination to obtain optimal outcome during pregnancy, birthing and post-natal period.
Q:If already on oral pill, what is the ideal duration between stopping medication and planning conception?
A: It can be as early as the next cycle itself.
Q:Does stress have a role in fertility during pregnancy and during delivery?
A: Definitely stress plays a major role at all stages. Stress has a negative effect on fertility. Stress and tension causes spasm of uterine end of fallopian tubes.It also causes disturbance in the level of all reproductive hormones.During pregnancy stress directly affects the physical and mental health of both mother and baby. Example: Maternal Hypertension and diabetes. During birthing delay in progress in the form of slow dilatation of cervix and descent of presenting part as well-known saying goes, “tense women tense cervix”.
Q:Does marriage among close relatives have any effect on the off-springs?
A: When marriage among close relatives takes place, some of the genetic disorders represented by recessive genes may become manifest in the off – spring.
Q:Once a lady misses a period, how early she should consult a doctor?
A: A Home-pregnancy test is preferable to be done between 32 to 35 days; if it is positive soon she can consult her doctor.
a) To confirm that the pregnancy is inside the uterus
b) To confirm the duration of pregnancy
Q:When a pregnancy loss occurs during first / second / third trimester, will it repeat in next pregnancy?
A: Earlier it was believed that most of the obstetric events recur in subsequent pregnancies. Now science is proving that each of these pregnancy losses is an independent event (except in gross congenital malformation of the uterus – Even here it is not 100%) and need not repeat in subsequent pregnancies. It is more of wrong understanding, wrong belief and fear than being the fact.
Q:What are the common symptoms of early pregnancy?
A: Amenorrhoea or absence of periods, nausea or vomiting, giddiness, increase frequency of urination, weakness, and excessive drowsiness are few common symptoms of early pregnancy.
Q:When does the lady appreciate first fetal movement?
A: If she is pregnant for the first time she will appreciate her first fetal movements around five and a half months and in subsequent pregnancies, a little early – around 5th month.
Q:Is it normal to experience breathlessness, palpitation (hearing one’s own heart beat), feeling giddy?
A: More than 80% of normal pregnant women experience breathlessness, palpitation and giddiness at some part of their pregnancy or other.
Q:Is it normal to have pigmentation of skin over face, abdomen and thighs?
A: Pigmentation is normally occurring over face, abdomen and thighs due to elevated levels of ACTH Hormones in pregnancy.
Q:Why does a lady experience increase vaginal discharge during pregnancy?
A: Increased Vaginal secretion during pregnancy is due to increased Vascularity to the whole genital tract and increased glandular secretion from vagina and cervix.
Q:Is low backache common in pregnancy? If so, why?
A: Change in the spinal curvature (increase Lumbar lordosis), softening and increased mobility of pelvic and lower spinal joints gives raise to low backache.
Q:Does weakness in the mouth of the uterus (Cervical Incompetence) recur in next pregnancy also?
A: Not necessarily. Regular clinical evaluation during pregnancy will help us to know the state of the mouth of the uterus.
Q:Once a caesarean, does it mean again caesarean?
A: There are two categories. If a caesarean is done previously for a recurring indication, like narrow birth canal, she needs a repeat caesarean. If it is a not recurring indication like fetal distress (variations in baby’s heart beat), a short trial for delivery through natural passage in a well-equipped set up, is possible. Previous two caesareans mandate caesarean delivery in the subsequent pregnancies.
Q:During third trimester can we know whether it is going to be normal / caesarean delivery?
A: One cannot exactly predict because of a small portion of unknown factor contributing to birthing like uterine contractions, yielding of birth canal and baby’s head and the behavior of baby and mother during delivery – all these factors can be evaluated only during active phase. A rough evaluation can be done two weeks prior to the due date.
Q:Is repeated ultrasound scanning harmful to the baby?
A: Ultrasound scan done judiciously to record the developmental milestones is very valuable. The wrong understanding about USG is that it is equalent to X-ray. In USG we use high frequency sound waves, which are safe in contrast to X-rays, which are harmful to developing fetus.
Q:Why do we need to do Ultrasound scanning in pregnancy?
A: USG is a very valuable non-invasive mode of investigation which helps in early detection of developmental abnormalities, in the rapidly growing fetus.
Q:Does 3D Scan give more information than 2D scan?
A: 2D USG gives adequate information about fetal development. In certain situation, we may need the assistance of 3D Scan also. (Ex. Cleft lips and palate)
Q:Does any complication in previous pregnancies like abortion, pre-term delivery, intra-uterine demise, neo-natal death, intra-uterine growth restrictions, high BP, diabetes, repeat in subsequent pregnancies also?
A: The latest scientific studies prove that these pregnancy complications need not repeat in subsequent pregnancies, because neither the mother is the same individual, nor the developing fetus the same. But the mother carries the same mental pattern which might influence the pregnancy outcome.
Q:Does maternal weight gain affect baby’s birth weight?
A: Yes. It does. Poor maternal weight gain is associated with growth restricted babies or small for date babies.
Q:Is travelling safe in pregnancy? (Either by road or air)? If so, which period is safe?
A: It is ideal to avoid travelling during first 12 weeks and last 3 to 4 weeks of pregnancy, as pregnancy is not well established (placenta not formed) in first trimester and to avoid inconvenience of developing birthing process while travelling during last 3 to 4 weeks.
Q:What is the normal weight gain during pregnancy?
A: A total of 10 to 15 kgs from third month onwards is considered to be normal gain in pregnancy. First 12 weeks she may or may not gain weight (she may gain 1 kg or she may not gain anything) later 0.5 kgs per week or two kgs per month is the normal weight gain.
Q:Is swelling of feet and face normal during pregnancy?
A: Minimal swelling of feet and face, which subsides on taking rest is normal in pregnancy; swelling which persists even after rest is generally associated with conditions like PIH (Pregnancy Induced Hypertension), renal disorders.
Q:What are the danger signals of pregnancy which should be reported to doctor immediately?
A: Following are few of the common symptoms of pregnancy which needs immediate medical attention:
a) Pain abdomen
b) Bleeding or watery discharge from vagina
c) Decreased fetal movements
d) Excessive swelling of face and feet
a) Pain abdomen
b) Bleeding or watery discharge from vagina
c) Decreased fetal movements
d) Excessive swelling of face and feet
Q:Can a pregnant woman do Yoga or Pranayama or walking during pregnancy?
A: Walking and Yoga or Pranayama done under Yogacharya’s guidance does immensely help the expectant mother in restoring the best physical, mental and spiritual health.
Q:Can we drive a two-wheeler / four-wheeler during pregnancy?
A: Long distance driving of any vehicle is to be avoided throughout pregnancy. Practically short distance driving which doesn’t interfere with maternal or fetal health should be ok.
Q:Can we continue working during pregnancy? When do you need to take off from work?
A: It basically depends on physical health and mental status of the pregnant woman. If the expectant mother is fit and she is comfortable she can work as long as possible.
Q:Do we need to avoid sexual intercourse during pregnancy?
A: In general sexual intercourse needs to be avoided during first 8-10 weeks and during last 4 weeks of pregnancy. Special precautions maybe needed in high risk situations like abortions, abnormal vaginal bleeding, vaginal infections, cervical incompetence etc.
Q:What practices in pregnancy help me to increase chances of having normal delivery?
A: Regular Yoga, Pranayama, and meditation under the guidance of qualified personnel, simple walking will help the expectant mother to maintain good muscle tone. Mental make-up of the mother along with good physical health goes a long way in going through the birthing process successfully.
Q:Is constipation common during pregnancy? How do we manage with dietary changes alone?
A: Constipation is common due to the effect of pregnancy hormones (progesterone) which flows down the motility of the entire gut. Constipation can be managed by consuming fiber-rich diet like green leafy vegetables, salads, fruits, and consuming plenty of liquids.
Q:Pregnant women commonly complain about sleep disturbances, especially insomnia, during later weeks of pregnancy. They want techniques to manage it without medication.
A: Simple measures like early dinner followed by a short relaxing walk, listening to soothing music will help her. Simple meditation techniques will be of immense value to overcome sleep disturbances.
Q:How do we manage headache, a very common complaint, without medication?
A: Simple deep breathing (Sukha Pranayama) and meditation techniques will help the lady to get relief from headache.
Q:How long I need to breast feed my baby?
A: WHO recommends exclusive breast feeding at least for first four months. Later on mother should make all efforts sincerely to breast feed as long as they can.
Q:How early I can get back to work?
A: A minimum of 90 days of restricted activity along with good diet is essential to recover from stress of pregnancy and labor. Basically it depends on the health of the mother and baby.
FAQ’s about newborn baby
Q:Is the baby healthy? What is the sex of the baby? What is the weight?
A: No – upto 35 years of Maternal age is fine though fertility peak is between 22 to 28 years of age.
Q:When do I start breast feeding?
A: As soon as possible, usually within 1 to 2 hours after birth. The milk produced in the first 3 days of lactation called the COLOSTRUM is very rich with antibodies and immunoglobulins which protect the child against infections.
Q:The milk seems inadequate in the first 3 days. Do I need to supplement?
A:No. Colostrum is secreted in small quantities, but is rich in energy and proteins and is adequate to meet the nutritional demands of normal healthy babies. There is no need to supplement.
Q:How often do I breast feed?
A:Practice on demand feeding, ideally every 2-3 hourly feeds.
Q:How will I know if my child is getting enough feeds?
A: Your baby will sleep well between feeds, void urine six or more times in a 24 hour period and will gain weight as per standard recommendations, as assessed by the pediatrician.
Q:My baby is passing black colored stools. Do I need to worry?
A: When marriage among close relatives takes place, some of the genetic disorders represented by recessive genes may become manifest in the off-spring.
Q:Once a lady misses a period, how early she should consult a doctor?
A:No. The stool passed in the first 2-3 days of life is called the Meconium and it is black and sticky in nature. In the next 2 days, it will be greenish in color
(transitional stools).The stools will change color to golden yellow after day 5 and he may pass even 10-15 stools in a day, after which it will settle down to 1-2
stools per day.
You need to worry if the baby passes white or clay colored stools with high colored urine or there is blood in the stools for which you need to contact the doctor
immediately.
Q:My baby cries/strains before passing urine or stool
A: It is normal for babies to do that. It facilitates the passage of urine and stool
Q:Baby is vomiting on and off after feeds. Is it normal?
A: Babies also take in air every time they suck for the feed. And it is natural for the air to exit from the system in the form of burps and flatus. The process also
brings out a certain quantity of milk with it and presents as vomiting. Also the sphincter muscle at the lower end of the food pipe is not strong enough and it is a
patent junction. The muscle layer strengthens around the 6th month and the problem resolves automatically.
Ensure good latching at the breast while feeding and burp the child well after every feed to minimize the regurgitation.
Only if the vomiting is painful to the baby or the baby is not gaining adequate weight due to the vomiting, it will need further evaluation and treatment. Also
persistent, projectile and bile stained vomiting needs to be evaluated..
Q:When do I bathe my child?
A: The baby can be given bath with warm water in a draught free room on the second day after birth. Smaller babies and preterm babies are preferably given
a sponge bath to prevent the risk of hypothermia
Q:Should I give multivitamin preparations?
A: Breast milk meets all the nutritional needs of your baby. There is no need to supplement unless the baby is preterm or low birth weight. Take wholesome
nutritious food instead, and what is needed will automatically reach your child.
Q:How long should I breast feed?
A:As long as you can, the longer, the better. Exclusive breast feeding is to be practiced for 6 months. Then on, add weaning food gradually, continue to
Ans:breast feed for 2 years.
Ans:Breast milk is wholesome food in the first 6 months; it has great anti infective properties. Breast fed babies are less likely to develop obesity, hypertension,
Ans:diabetes and atherosclerosis in later life. They have better cognition and higher IQ score.
Ans:The benefits to the mother are immense. It helps in maintaining lactational amenorrhea (a natural method to ensure birth spacing), helps with the involution of the
Ans:uterus and affords some protection against breast and ovarian cancer.
Q:My baby looks jaundiced!
A: It is a normal phenomenon in newborn babies. Jaundice appears on day 2-3, reaches maximum intensity by day 4 and disappears by 10 days of life.
Nature’s supreme wisdom protects newborn babies with the bilirubin which has antioxidant properties.
However, jaundice appearing in the first 24 hrs of life, deeply jaundiced baby with lethargy, poor feeding and jaundice persisting for more than 14 days needs to
be attended to.
Q:How do I recognize a sick child?
A: Consult a doctor immediately if you recognize any of these conditions:
i) Persistent vomiting or diarrhea
ii) Poor feeding
iii) Undue lethargy or excessive crying
iv) Failure to pass meconium within 24 hrs and urine within 48 hrs
v) Breathing difficulty
vi) Bleeding from any site
vii) Appearance of Jaundice within 24 hrs of age
viii) Jaundice not resolving after 10 days of birth
ix) Excessive drooling
x) Blue baby
xi) Any infection in the body-pustules, in the eyes, oral thrush etc
Q:The legs are not straight
A: It is normal for babies to have bow legs. It will gradually resolve after the first birthday, more so when the child starts walking.
Q:There is a spot of blood in the eyes!
A: It is a common occurrence during the passage of the baby in the birth canal. Though it looks very alarming, it will disappear spontaneously in a few days without any pigmentation.
Q:There is a swelling in the baby’s breast.
A: Breast engorgement happens due to the maternal hormones being present in the baby’s blood. It will last for a few days or weeks and will subside on its own. Please do not massage or try to express milk from the engorged breast.
Q:My daughter had bleeding from the vagina
A: This is also the effect of the maternal hormones in the baby. It happens after 3-5 days of birth, is mild and will last for 2-4 days. Clean the area well and maintain hygiene
Q:The baby’s head shape is not symmetrical
A: Based on the in utero position of the head, the baby may develop an odd shape. With proper positioning of the head and with the passage of time, it will gradually round up..
Ultrasound in Pregnancy
Ultrasound in recent years has proven to be an invaluable and cost effective investigative tool for Obstetricians in pregnancy. The indications for a scan in pregnancy are very many and when used judiciously can help the doctor to intervene at the right time, making it safe for the mother and the baby
First Trimester
[5+ to 10 weeks]
The pregnancy or gestational sac can be identified first around 5 weeks through a trans-vaginal ultrasound examination. The contents of the sac, the yolk sac [which provides nutritive support to the embryo] and the fetal pole can be visualized by 5-6 weeks. The cardiac activity in the embryo which tells us that the embryo is viable is comfortably imaged by 6-7 weeks.Very often an indication for a scan so early in pregnancy, would be a history of previous pregnancy loss or a pregnancy situated outside the uterus i.e,, an ectopic pregnancy. The scan is confirmatory in terms of location and the gestational age and therefore helps in instituting supportive therapy.
In those patients who have irregular cycles, this scan gives accurate dating of the pregnancy to within 3-5 days of the actual age of the mbryo.Multiple pregnancies such as twins or triplets, their type in terms of identical or fraternal are also best identified at this time. In those patients, where the rapy has been given to assist in reproduction, this situation can be anticipated as there may be formation of more than one ovum or egg.First trimester scan gives accurate dating of the pregnancy to within 3-5 days of the actual age of the embryo.Other associated problems could be spotting or bleeding in the first trimester—a threatened abortion when a scan may identify whether the embryo is still viable or not and on the event that it is not viable whether the products of conception have been expelled completely or not.Intervention in terms of suction and evacuation or simple medical line of management can be resorted to in the presence of retained products of conception.The other indications for an ultrasound in early pregnancy would be to identify associated lesions in the uterus such as fibroids or those in the adnexae like pathological cysts in the ovaries or para-ovarian cysts. This prepares the Obstetrician in addressing problems related to these lesions in the course of pregnancy. As the pregnancy advances there is technical difficulty in identifying these lesions.
The pregnancy or gestational sac can be identified first around 5 weeks through a trans-vaginal ultrasound examination. The contents of the sac, the yolk sac [which provides nutritive support to the embryo] and the fetal pole can be visualized by 5-6 weeks. The cardiac activity in the embryo which tells us that the embryo is viable is comfortably imaged by 6-7 weeks.Very often an indication for a scan so early in pregnancy, would be a history of previous pregnancy loss or a pregnancy situated outside the uterus i.e,, an ectopic pregnancy. The scan is confirmatory in terms of location and the gestational age and therefore helps in instituting supportive therapy.
In those patients who have irregular cycles, this scan gives accurate dating of the pregnancy to within 3-5 days of the actual age of the mbryo.Multiple pregnancies such as twins or triplets, their type in terms of identical or fraternal are also best identified at this time. In those patients, where the rapy has been given to assist in reproduction, this situation can be anticipated as there may be formation of more than one ovum or egg.First trimester scan gives accurate dating of the pregnancy to within 3-5 days of the actual age of the embryo.Other associated problems could be spotting or bleeding in the first trimester—a threatened abortion when a scan may identify whether the embryo is still viable or not and on the event that it is not viable whether the products of conception have been expelled completely or not.Intervention in terms of suction and evacuation or simple medical line of management can be resorted to in the presence of retained products of conception.The other indications for an ultrasound in early pregnancy would be to identify associated lesions in the uterus such as fibroids or those in the adnexae like pathological cysts in the ovaries or para-ovarian cysts. This prepares the Obstetrician in addressing problems related to these lesions in the course of pregnancy. As the pregnancy advances there is technical difficulty in identifying these lesions.
First Trimester
In the last few years based on the measurement of the thickness of the translucency in the region of the neck of the foetus and the length of the fetus a risk assessment for chromosomal abnormalities like Down’s syndrome ( Trisomy 21) and Trisomy 13 & 18 can also be assessed.This scan also involves looking for the nasal bone in the baby.First trimester screening gives a risk assessment for certain chromosomal abnormalities.The risk is arrived at after correcting the already existing risk in the mother based on her age. A biochemical screening which involves obtaining the blood levels of certain hormones during the first trimester is also complementary in identifying the risk for chromosomal anomalies in the baby.The risk can never be zero and if it is negative also it does not mean that the baby does not have chromosomal anomalies. It just means the risk is low.On the event that the risk assessment turns out positive it does not mean the baby definitely has a chromosomal abnormality. It just means that the baby is at a higher risk and certain invasive tests like taking a sample of the placental tissue or amniotic fluid or blood sample of the foetus may be required to get the actual chromosomal status of the baby and rule out an abnormality.
The 18-23 Weeks Scan
The scan performed during this period is the most important of all the scans and is indicated in every pregnancy. This is otherwise known as ‘Mid – trimester Anomaly Scan’.
This scan picks up physical abnormalities in the baby. This is the best time to visualize the foetus well, as the organs are large enough for comfortable imaging.Besides the baby is also very active and therefore makes visualization relatively easy.It becomes important to understand that all abnormalities in a foetus cannot be picked up on ultrasound. Besides, maternal obesity largely comes in the way of the examination as the penetration the ultrasound waves in these women is poor. The skill and the experience of the sonologist and the ultrasound machine also plays a key role in providing a ‘sound’ report All abnormalities in a foetus cannot be picked up on ultrasound.
In case the screening for chromosomal anomalies has been missed in the first trimester, it can be done at this time usually between16-21 weeks to identify the same.Scans performed subsequently assess the growth of the fetus and the biophysical profile in terms of its body movements, breathing movements and limb movements. The quantity of fluid around the fetus can be assessed and also the estimation of fetal weight. Few abnormalities in the fetus come to light only at this time. The scan done at this time can help in decision making with respect to time and mode of delivery. Blood flow study to the uterus and the fetus otherwise known as a Doppler study can also aid in decision making.
This scan picks up physical abnormalities in the baby. This is the best time to visualize the foetus well, as the organs are large enough for comfortable imaging.Besides the baby is also very active and therefore makes visualization relatively easy.It becomes important to understand that all abnormalities in a foetus cannot be picked up on ultrasound. Besides, maternal obesity largely comes in the way of the examination as the penetration the ultrasound waves in these women is poor. The skill and the experience of the sonologist and the ultrasound machine also plays a key role in providing a ‘sound’ report All abnormalities in a foetus cannot be picked up on ultrasound.
In case the screening for chromosomal anomalies has been missed in the first trimester, it can be done at this time usually between16-21 weeks to identify the same.Scans performed subsequently assess the growth of the fetus and the biophysical profile in terms of its body movements, breathing movements and limb movements. The quantity of fluid around the fetus can be assessed and also the estimation of fetal weight. Few abnormalities in the fetus come to light only at this time. The scan done at this time can help in decision making with respect to time and mode of delivery. Blood flow study to the uterus and the fetus otherwise known as a Doppler study can also aid in decision making.