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Pregnancy - The First Trimester

It seems the season of the swelling Belly is here again, as every day brings a new client to my office. Why is it that at this time of year I always get an influx of expectant parents anxious and eager to know everything about their new condition? Could it be “spring” in Bali, or perhaps it has something to do with the recent “Nyepi” day of silence when we are bound to stay within the confines of our own homes? Whatever the case, there are always a multitude of questions to answer about pregnancy and it’s why’s and wherefores. Here are some of the more common queries that tend to concern the “expectants”.
When should a woman have her first prenatal visit? After the first visit, how often should a woman see her doctor?
Women should see their physician or midwife as soon as pregnancy is suspected to maximize prenatal health care and to minimize risk for birth defects and complications. Seeing   a health care provider to begin prenatal care by the 10th week of pregnancy is recommended. Screening blood tests, starting prenatal vitamins and early detection of problems are better accomplished sooner rather than later. A physical examination and screening for sexually transmitted diseases are part of the first prenatal visit.
When should a woman have her first ultrasound?
A first trimester ultrasound is indicated at 11 - 12 weeks when a first trimester screen to calculate risks of fetal  abnormality can be performed. A scan at 16-20 weeks’ gestation is a common and acceptable time for accurate detection of most major fetal anomalies (detailed fetal anatomy scan). This timing allows a woman to make a decision regarding termination.
What are the signs of a miscarriage?
Bleeding, passing tissue, rupturing membranes (passing clear fluid), and clotting are all typical signs of an aborting fetus. Some women also report a loss of the usual side effects of pregnancy, such as resolution of nausea or loss of breast tenderness. Not all women who bleed during pregnancy progress to an abortion.
Almost one fourth of women experience implantation bleeding and most of these women will go on to a  normal pregnancy.
Many abortions are due to chromosomal abnormalities. Almost 90% of pregnancies lost in the first trimester have chromosomal abnormalities, and almost one third of pregnancies lost in the second trimester have a chromosomal abnormality.
Is cramping during pregnancy normal?
Early in pregnancy, uterine cramping can indicate normal changes of pregnancy initiated by hormonal changes; later in pregnancy, it can indicate a growing uterus. Cramping that is different from previous pregnancies, worsening cramping, or cramping associated with any vaginal bleeding may be a sign of ectopic pregnancy, threatened abortion, or missed abortion.
Why do pregnant women feel tired?
Fatigue in early pregnancy is very normal. Many changes are occurring as the new pregnancy develops, and women experience this as fatigue and an increased need for sleep. Lower blood pressure, lower blood sugars, hormonal changes, metabolic changes, and the physiologic anemia of pregnancy all contribute to fatigue. Women should check with their physician or midwife to determine if an  additional prenatal vitamin and/or iron would be beneficial. Other physical effects that are normal during           pregnancy, and not necessarily signs of disease, include nausea, vomiting, changes in bowel habits, increased   urinary frequency, palpitations or more rapid heart beat, swelling of the ankles, and shortness of breath.
What are the safest treatments for nausea and vomiting in early pregnancy?
Nausea and vomiting occur frequently in pregnant women, especially during the first trimester. Nausea and vomiting often are difficult to treat, especially because they           generally occur in the first trimester. This is the most critical time for fetal organ development, minimal pharmaceutical usage is recommended. Dietary strategies usually are the best treatment. Some patients should only consume foods they know they tolerate well. For others, dry crackers, lemonade, peppermint and ginger products may be helpful. Vitamin B-6 also can   decrease nausea and may be administered orally, or by injection.
How much alcohol is safe to consume during pregnancy?
No amount of alcohol is considered safe. Fetal alcohol syndrome (FAS) has been reported with very low levels of consumption. Pregnant women who drink even           minimal amounts of alcohol may be compromising fetal development. Heavy drinking (3.5 drinks per day) during pregnancy remains an established risk factor for FAS and other adverse perinatal outcomes. FAS is completely preventable, but it is not curable once alcohol has damaged the fetus. Fetal consequences of FAS include mental retardation or borderline mental deficiencies and intrauterine growth restriction with all parameters of growth lagging-length, weight, and head circumference. Drinking during month 7 increases the odds of preterm delivery, even for light or moderate drinking.
Should pregnant women avoid certain foods to  prevent listeriosis?
Listeriosis is an illness caused by the bacteria Listeria monocytogenes, which produces a mild to more moderate gastrointestinal illness with nausea, vomiting, and diarrhea. It typically is food born and can cause fetal damage or miscarriage. Pregnant women should not consume unpasteurized milk or soft cheeses; cold meats; or undercooked or raw animal foods, such as meat, fish, shellfish, or eggs. All fresh fruits and vegetables should be washed thoroughly before consumption by a pregnant woman.
Is it safe for women to eat fish while pregnant?
The fish themselves are not harmful, but extensive fish consumption increases exposure to the naturally occurring compound methylmercury, levels of which have been increasing in the waters due to industrial pollution. Mercury is very toxic and can cause danger to the fetus and to the newborn nursing infant. Longer-lived and larger fish, such as shark, marlin, king mackerel, and tuna, have increased mercury levels and cause the most concern for consumption by pregnant women. The FDA therefore advises that pregnant or nursing women can safely eat 12 ounces per week of cooked fish if they select the smaller fish and eat a variety of fish.
Is it safe for women to dye their hair during pregnancy?
Hair dyes are thought (most likely) to be safe to use during pregnancy because actually very little is absorbed through the skin. The hormonal changes of pregnancy and the speed of hair growth (usually improved during pregnancy because of better nutrition and more vitamin use) will make the color of the hair vary in response to dying and the roots growing out faster. 
Can a woman still exercise during pregnancy?
Women should exercise during pregnancy to maintain a certain level of fitness as well as body tone. Certain stretching exercises may be beneficial to the birth process (i.e. pregnancy yoga). Make sure that your instructor is aware that you are pregnant. Avoid high impact exercise, as well as overheating. Ideal exercises would be swimming, bike riding, & walking.Be aware that as your belly grows your center of balance of thrown forward; this may cause loss of balance to occur easier than in a non pregnant state. Avoid saunas or hot tubs as the may cause overheating of the womb and circulatory problems for the growing baby.
“ Kim Patra is a qualified Registered Nurse and Midwife that has been living and working in Bali for almost twenty years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at”.
Copyright © 2005 Kim Patra
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