9 MONTHS 10 DAYS (A lot about pregnancy)
Pregnancy is one of the most special periods in a woman’s life. There are various rules that the pregnant woman and her environment must follow in order to pass this process in which the child, the supreme product of man, emerges. Additional findings that occur with the delay of menstrual bleeding, suggests pregnancy. These are tightness in the breasts, sore nipples, increased discharge, mild low back pain, burning during urination and increased salivation. are such symptoms. Later on, morning sickness and vomiting may sometimes occur. To calculate the expected date of delivery, 7 days are added from the first day of the last menstrual bleeding and 3 months are subtracted (for example, the expected delivery date of the pregnant woman whose first day of menstruation is the 9th of the 6th month will be the 16th of the 3rd month). This rule applies to women with regular menstruation. Those whose menstruation is usually delayed will have a later expected due date.
With today’s pregnancy tests, pregnancy can be detected with a delay of a few days in the urine and without delay in the blood.In the first examination related to pregnancy, occurring outside the uterus, encountered in approximately 0.5-1% of women, life-threatening if not terminated, possibility of ectopic pregnancyshould be eliminated. In addition, anatomical disorders such as benign uterine tumors called fibroids, which occur up to 25% in advanced age pregnant women, congenital anomalies of the uterus and ovarian cysts, which are predicted to be noticed in the first examination in young people, can be detected in around 3%.In their evaluation, Vaginal ultrasonography, which can be safely applied in the first 3 months of pregnancy,We must emphasize its importance.
Pregnancy is 40 weeks from the first day of the last menstrual period, and it will be safer to evaluate this process by specifying the weeks instead of the months. By the end of the first 12 weeks, most of the organs of the pregnancy product will be completed, and the fetus with a head-rump length of 6-7 cm and a head larger than the body will be formed. One end of the umbilical cord extends to the placenta, which forms the connection with the veins in the mother’s uterus, which is called the wife or son. It floats in water called amniotic fluid, inside the growing uterus like a balloon.
Unfortunately, only nine out of ten pregnancies complete 12 weeks. One in ten pregnancies will end in miscarriage.Here is a fact that should not be ignored, severe chromosomal abnormalities in at least 60% of miscarriages is existence. In short; An important part of the mentally handicapped such as Mongolian, chromosomal diseases such as Turner’s syndrome and many disabilities that are incompatible with life result in miscarriage. During the miscarriage, the growth of the pregnancy will stop, the fetal heartbeat, which can be seen after 5-6 weeks, will not be seen, the gestational sac will be deformed, and severe bleeding will occur with cramps. Abortion should be performed in order to prevent long and severe bleeding and infection, which are the remaining parts of most of the abortions.
The risk of miscarriage and preterm birth between 12-28 weeks is considerably reduced and can go down to 1%. Here, apart from the disability of the fetus, structural anomalies of the uterus, laxity of the cervix (with vaginal ultrasonography, it may be recommended to suture with canal opening more than 8 mm)It plays a role in infections such as toxoplasma.
Between the end of 28-37 weeks, the probability of preterm birth increases again and reaches one in ten. It is more common than one in five in twin and other multiple pregnancies, in preeclampsia, which is manifested by high blood pressure edema and albumin in the urine. In the last 3 weeks, the lungs of the baby will have matured and the risk of premature birth will disappear. One of the most disturbing issues for pregnant women and their relatives is the situation of encountering any disability in the baby. All around the world An average of 3% of all children born have a life-threatening or non-life-threatening disability.. Only 60-70% of these anomalies can be detected by routine ultrasonography. Generally, the first anomaly scans start between 11-14 weeks. In this period, the nuchal translucency of the fetus is measured. In general, with a nuchal translucency of more than 3 mm, the risk of chromosomal diseases such as Down syndrome and congenital heart disease increases in the baby. . In this period, the absence of the baby’s nasal bone, heart rate and some Doppler ultrasonography findings are the harbingers of some chromosomal diseases. The examination of the blood sample taken from the mother on the day the nuchal translucency is measured is called the double test. As a result of evaluating the ultrasonography measurement and the dual test together, we can get away from the possibility of down syndrome by 85%. . In case this test cannot be performed, a blood sample taken from the mother between 16-20 weeks The success of the examination, which we call the triple test, will only be 70%. . If the tests are suspicious, amniocentesis is usually recommended between 16-20 weeks. In amniocentesis, a sample is taken from the amniotic fluid in which the baby swims, accompanied by ultrasonography, and sent to the genetic laboratory. The probability of pregnancy resulting in miscarriage after this procedure is so low that it is less than one percent. Amniocentesis should not be avoided in women 37 years of age and older and in all suspicious cases recommended by a perinatologist. These tests are often used to detect chromosomal diseases such as Down syndrome. We can detect a significant part of many other anomalies only by ultrasonography. . Again, in doubtful cases, detailed ultrasonographic evaluations (second, third level), echocardiography related to the baby’s heart may be recommended.
THINGS TO DO BEFORE CONCERNING
Usually, a woman’s preparations for pregnancy begin three months before conception. The pregnant candidate starts using folic acid and continues until the end of the 12th week of pregnancy. Folic acid can reduce the risk of spina bifida (opening of the spinal canal), hydrocephalus (enlargement of the head and pressure on the brain) seen in approximately 1/400-1/1000 babies by 70%. . The pregnant candidate should give up smoking, alcohol and caffeine habits. 3 cups of coffee, instant coffee or 1.5 liters of cola a day would increase the risk of a disabled baby. r. Women who want a child should not use drugs, stay away from radiation, and should not dye their hair unless they have to, after the ovulation period. headache, toothache and Pure paracetamol in fever above 38.5Containing drugs can be used safely up to 2 gm a day (4 times a day). If you get pregnant in cases with high blood sugar, the possibility of miscarriage and baby with anomalies increases. . Diabetes should be excluded in all women in the risk group. The blood group of the couple should be known, if the woman is Rh negative and the man is Rh positive, the necessary tests should be done during pregnancy due to blood incompatibility. When the baby’s blood group is positive after birth, it is given to the mother so that there is no risk to the child in the next pregnancy. The Anti D injection should be administered no later than three days after birth.Anemia, which we call anemia, should be detected with a simple blood count called hemogram, and if there is iron deficiency, it should be treated with iron pills, which we call blood pills, for two months. When the MCV value is found below 80 in the blood count, thalassemia (Mediterranean anemia) carrier, which is encountered in 3% of the population, is suspected and the blood count of the woman’s spouse is also evaluated. . If these values are below the limit in both, a special blood test called hemoglobin electropheresis should be performed on this couple. When both of them are proven to be carriers of Mediterranean anemia, the risk of the baby getting sick is one in four, and chorionic villus biopsy should be done before the first 12 weeks of pregnancy.(taking a sample from the placenta with a special technique) is applied.
In addition, urinary tract infections should be treated before pregnancy and dental treatments should be done. Precautions should be taken for toxoplasmosis, which can be transmitted through cat feces and increases the risk of miscarriage and disabled babies. and vegetables should be washed well, meat should be cooked well, sausage, salami, sausage should be cooked and eaten, raw meatballs should not be eaten and hands should be washed well before eating.Pre-pregnancy precautions should also be followed during pregnancy.
HOW MUCH WEIGHT SHOULD WE GAIN IN PREGNANCY?
We can calculate it like this. At the time of birth, the baby is about 3-4 kg, the amniotic fluid is 900 g, the placenta is 900 g, the weight of the uterus is 900 g, the breasts grow 1-2 kg, the blood volume increases 1-1.5 kg, and if a predictable increase in body fat is 1-2 kg, the expected weight increase will be 10-12 kg. It would be more appropriate for thin and tall women to gain up to 15 kg, and for overweight and short women to gain 8-9 kg. . Usually, weight can be lost in the first 3 months due to nausea, however, a total of 4-5 kg can be gained until the 24-25th week of pregnancy, then no more than half a kg of weight should be gained per week. . If half a kg of weight is gained per week from the beginning of pregnancy, this will reach a total of 20 kg in 40 weeks. Pregnant women should be weighed with their own scales in the morning, naked, hungry, with an empty bladder and intestines. . We must bear in mind that clothes, a full bladder, stomach and intestines can mislead the scale by even a few kilos. The scale should be on hard and smooth ground and 0 setting should be made.
HOW SHOULD WE FEED IN PREGNANCY?
While she wants to feed the pregnant baby well, she should be careful not to gain too much weight. The average daily intake of pregnant women is 2300 calories. Vitamins, proteins and carbohydrates constitute the nutritional requirement of the pregnant. Vitamins are found in vegetables, salads and fruits. While these can be taken in large amounts during pregnancy, attention should be paid to the calorie dose. (a cucumber 20 calories, an apple 60, a banana 100 calories).Animal proteins such as meat, chicken, fish should be taken as grilled, boiled, baked, steamed, and oily frying should not be eaten. After the 16th week of pregnancy, milk should be given importance, and 1 liter of dairy product should be consumed per day. (If there is nausea and disgust in the first 16 weeks, it should not be forced to drink milk. 1 hard-boiled egg can be eaten per day. Vegetable proteins such as beans, chickpeas, and lentils may increase gas pains after 24-25 weeks of pregnancy, due to reflux caused by the rising uterus pushing the stomach up, and the 12-meter intestine located in the narrowing part of the abdominal cavity. In this case, drugs such as Metsil can be used safely. As bread, choosing pulpy foods such as oats and rye is suitable for bowel movements.
We must emphasize that it is necessary to drink plenty of water during pregnancy. Consuming at least 2 liters of fluid a day will reduce the complaints of nausea in the first 12 weeks, reduce the risk of urinary tract infection especially in the 12-28 weeks, and reduce the chance of premature birth in the last three months. In the meantime, we should emphasize that frequent urination during pregnancy is usually due to the pressure of the rising uterus on the bladder, and we should not restrict fluid intake. The increase in circulating fluid is protective against blood pressure drops, especially in the middle three months of pregnancy. blood pressure thought; dizziness, fainting, nausea and blackouts may occur. It is usually not dangerous and no medicine is used. Lifting the feet up, salted buttermilk and small candies will help. In order to prevent blood pressure from falling, it is recommended to prevent the growing uterus from compressing the blood flow from the feet to the heart. We should lie on your side instead of your back, should not bend over and get up quickly, especially in the heat, we should not stand constantly and take a hot shower, since the loss of fluid will be high.
It usually lasts up to the first 12 weeks, sometimes until the end of the 16th week, rarely throughout the pregnancy. The biggest fear of pregnant women and their relatives is that the baby will not gain enough weight. It should be emphasized here; Normally, the baby is already 90 g at the end of 12 weeks, and 150 g at 16 weeks. it will be . (A glass of water 200 g). Pregnant women may lose some weight during this period. The drugs used are often not helpful. It is recommended not to take fatty foods and to take plenty of watery foods. Chickpeas and crackers can help. Pregnant women should eat small, frequent snacks. It may be helpful not to get out of bed quickly, and to snack on foods such as a salty bar on the side of the bed before getting up. (in foreign classic books, it is recommended that the wife bring breakfast to bed!) . It will also be useful to change the environment and take walks in the fresh air. When vomiting more than 4-5 times a day lasts for a long time, a simple urinalysis is performed and the ketone body (acetone), the breakdown product of body proteins, is checked. When the amount of this substance increases in the urine, serums can be inserted to maintain fluid and electrolyte balance.
In the second half of pregnancy, especially as a result of the rising uterus pushing the stomach up and stomach acid escaping into the esophagus, reflux symptoms such as sourness, pain, scratching, burning in the throat may increase, especially with frying, bitter, pickles and spices. Paying attention to these It is recommended not to eat dinner late, take a walk after dinner, not sleep with a full stomach, preferably sleep on a high pillow. . Gaviscon (three times a day after a meal) is now recommended for such complaints. The World Health Organization stated that proton pump inhibitors such as Omeprol and Lansor can be used safely throughout pregnancy.
Considering that a full plate of cookies exceeds 4000 calories, hazelnuts Not to buy more than 4-5 products such as peanuts, almonds, walnuts. We should also emphasize that We should try to avoid chocolate, baklava and other high-calorie foods. There is no harm in freezing in a certain dose.
Wet skin, which we call mucous, becomes edematous during pregnancy. Nosebleeds increase with the effect of air conditioners, especially in dry environments. In this case, steam, humidification and physiological saline are recommended (ocean water). The gums we call gingiva become edematous and bleed. Gums are retracted, the penetration of microbes increases the chance of cavities and the progression of cavities. Severe dental interventions in the last three months are not recommended due to the risk of stress and infection triggering preterm labor. Therefore, dental evaluation is appropriate at the median trimester, which is the safest in pregnancy. During this period, threading, filling, cleaning and some operations can be applied. . Local anesthesia (numbing) and many antibiotics used to prevent infection are safe in this period.
When brushing the teeth, the toothbrush should enter the mouth dry, the upper teeth should be brushed from the bottom up, the lower teeth should be brushed from the bottom up, and it should be brushed from the gingiva at an angle of 40 degrees. Toothpaste and its quantity are not important.Then the mouth is rinsed.
Vaginal discharge increases in most pregnant women. Fungal discharge, which we call cotton, in the mouth of babies will occur in half of all pregnant women. Generally not dangerous. There is a white, odorless discharge that can sometimes be as thick as cut cheese. There may be increased itching towards the evening. There may be a burning sensation at the entrance of the vagina during sexual intercourse and urination. When symptoms are disturbing, it is usually treated with imidazole derivative creams and suppositories. Hygiene is important. After using the toilet, it should be washed from front to back and dried well. All mushrooms love moisture. After the bath, it should be dried quickly and should not be sitting in a wet swimsuit. Chlorine in the pool actually protects from infection, but since chlorine is actually basic, it will affect the acid vaginal balance, and the amount of fungus living in the vagina will increase and the findings of discharge will increase. Pregnant women can enter the pool and the sea at any time. . Swimming and walking are the best sports for pregnant women. Sunbathing is not recommended. (ozone layer hole, ultraviolet?)
Sexual intercourse can be allowed from the beginning of pregnancy to patients with appropriate examination findings and who are not in the risk group. However, after 28 weeks, contact with semen in the vagina is not recommended. Substances called prostaglandins in semen can affect uterine contractions and affect the risk of preterm birth, which is one in ten in the last three months. It would be appropriate to use condoms during this period. . Excessive stimulation of the breasts will increase the risk of premature birth by affecting the uterine contraction.
The swelling of the growing uterus during pregnancy will be noticed outside the pelvis bones after the first 12 weeks, and the height of the peak will reach the belly button of the pregnant woman in the 22nd week. It is not recommended for pregnant women to wear tight trousers and tight belts, as they will affect blood circulation to the uterus. Due to the forward displacement of the body’s center of gravity and the weight of the growing breast tissue, back, shoulder and low back pains increase. Standing and sitting upright, shoes with medium heels are recommended. Supportive bras that are not tight or baggy are recommended. Wearing the bra day and night will slightly reduce the possibility of sagging breasts.
Standing and sitting upright will slightly reduce the complaints of shortness of breath and palpitations that may occur, especially in the last three months, due to the rising uterus sinking under the ribs and pushing the diaphragm, compressing the heart and lungs. In this case, avoiding gas-forming foods will slightly relieve the pressure of the air-filled intestines. . (even a plate of beans during this period can sometimes cause groin, waist, back, shoulder pain, shortness of breath, palpitations, cold sweats and writhing gas pains)
While the uterus continues to grow rapidly, especially; When stress, fatigue and body resistance are broken, groin and lower back pain will increase due to the stretching of the ligaments holding the uterus and will usually improve after resting. In the second half of the pregnancy, the gap between the roof bones, which we call the pelvis, will increase, the angle between the thigh bone and the pelvis will deteriorate, the pregnant will walk wobbly and unbalanced. Especially at high steps, while getting on the bus and getting out of the bathroom, the pregnant woman will lose her balance and fall.
Since the blood flow returning from the legs may be prevented during the advancing pregnancy process, varicose and hemorrhoids The risk of hemorrhoids will increase. Instead of standing in the same spot without moving It is recommended to change positions as if stepping on a ladder and to be walking. Long journeys in a sitting position are not recommended.(Risk of varicose veins and hemorrhoids in long-distance drivers!). While sitting, the feet should be lifted and the legs should not be crossed.
After all, it is controversial to emphasize that pregnancy is a physiological event. It seems that at least as much as healthcare professionals, pregnant women and their environment have a lot to do. Our goal should be to pass the pregnancy with the least damage to the mother and the baby and to keep the quality of life high. However, the sublime feeling created by the desire to be a mother will make this period special and valuable despite everything.