Articles

I'm Pregnant!

By Department of Obstetrics & Gynaecology, KK Women's and Children's Hospital


There are few experiences in life as powerful as finding out that you're pregnant. It's amazing to think
that you have a new life growing inside you. From the moment you begin to feel changes in your
body, -- or you know for sure that you're pregnant, you may begin to feel unprepared for all these
changes and have a lot of questions to ask. As you look forward to having your baby, you would also
probably begin to think about arranging for your maternity care.


Frequently Asked Questions:
What Does Antenatal Care Mean?
Antenatal care is designed to ensure that your body is well prepared to cope with the pregnancy and
look for anything that could affect your growing baby. At each visit, you will have a chance to discuss
with your obstetrician on any questions or concerns that you might have. A detailed medical history is
taken at the first visit to identify and anticipate any potential complications that you might face. Your
blood pressure, weight and urine will also be checked. Your doctor will also examine your abdomen or
perform an ultrasound to ascertain the position and size of the baby. In the later weeks of pregnancy,
your baby's heartbeat will also be detected using a small hand-held machine called a Doptone. The
antenatal assessment also involves the following blood tests:

  • A full blood count to detect anaemia (low red blood cell counts which leaves you tired and less able to cope if you lose too much blood during or after the birth, this may sometimes be due to thalassaemia- a common genetic blood disorder in Singapore). Other parameters which could be abnormal in the full blood count like low platelet levels occur less commonly.
  • Blood grouping in the event a blood transfusion would be required. Screening for hepatitis B, HIV and syphilis: the implications on your baby may be significant should these infections be present
  • Rubella antibody screening (optional) to establish a history of exposure to this infection

Depending on your medical history, more detailed blood or urine investigations may be required as
well. Your baby’s development will be monitored with ultrasounds or serial physical examinations to
ensure proper growth at different stages of pregnancy.


Should I have prenatal screening for fetal anomaly?
You will be offered the following screening tests:

  • A first trimester screening test at 11-14 weeks involves a blood test and ultrasound. Down’s syndrome is one of the more common abnormalities that could happen in the genetic makeup of the baby. Children with Down’s syndrome have other defects like heart and kidney problems aside from mental retardation. This test stratifies the risk of Down’s syndrome for your current pregnancy. It is non-invasive and detects up to 90% of affected babies.
  • A blood test (serum screening test) at 15 -18 weeks of pregnancy that analyses 3 different substances in the blood. An estimate of the risk of having a baby with a chromosomal abnormality can then be obtained.
  • If the estimated risk is high for either of the screening tests mentioned above, a diagnostic test e.g. amniocentesis (fluid obtained for the water bag) or chrionic villous sampling (placental biopsy) would be recommended.
  • A detailed ultrasound scan (anomaly scan) at 19-22 weeks. This looks for physical abnormalities. There are however, limitations to the accuracy of the scan.

Do I need a special diet for two?
It is a common myth that you should eat for two. In fact most women do not need extra calories for the
first six months of pregnancy and only require approximately 200 extra calories per day during the last
three months.


However, because your blood sugar levels fluctuate more due to the extra demands on your body, it
is important to eat regularly, including snacks between meals. Most women gain between 9 - 13 kg
during pregnancy, although this can vary from woman to woman. You should never try to diet during
this period as you could be depriving the baby of vital nutrients.


Healthy foods
The best thing to do throughout pregnancy is to eat a variety of healthy foods. They should contain
certain key components necessary for growth and development. These include foods containing iron
(e.g. green leafy vegetables, red meat, beans and pulses although additional iron supplements may
also be given to you by your doctor); calcium (e.g. dairy produce, fish with edible bones like sardines
and bread) and folate (e.g. green beans, oranges, spinach, kale or broccoli).


Try to eat something from the following food groups daily:

  • Fresh fruit and vegetables: –four to six servings/day
  • Bread, rice, breakfast cereals, potatoes: at least 1 serving at each meal and 4 servings/day
  • Lean meat, poultry, fish, eggs, pulses and nuts: –two to three servings/day
  • Dairy products: –two to three servings/day

Try to avoid the following:

  • Raw eggs which may sometimes contain a bacteria called Salmonella
  • Mayonnaise
  • Blue cheese
  • Liver or pates
  • Raw or undercooked meat and raw shellfish
  • Soft cheese and unpasteurized milk

It is also important to observe strict hand hygiene and to prepare food that is properly washed and
cooked to avoid contamination with any germs.


In addition, the body’s abilities to handle sugar may be impaired resulting in the development of
diabetes in some ladies. Your doctor and dieticians will advise you on the appropriate diet.


Why is folate important?
Folate is a vitamin crucial in the development of baby's brain and spinal cord. It has been shown to
reduce the chance of having a baby with a neural tube defect (a disability affecting the nervous
system). Folate is easily destroyed during cooking and larger servings are necessary for adequate
intake. The simplest way is to take a folate supplement (one 400 mcg tablet or one 5mg tablet daily
which is the form that is avaliable in singapore) for the first 12 weeks of pregnancy. Folate is
particularly important if you suffer from epilepsy or have a family history of neural tube defects.


Why do I feel bloated?
This is because you are retaining fluids cause by the hormones produced during pregnancy. Also, the
hormones cause the digestive system to move more slowly than a non-pregnant state, resulting in a
longer period of food retention and constipation. Eat smaller amounts of foods at more frequent
intervals during the day and avoid lying down immediately after eating.


Water retention
Water retention (or edema) is a common complaint that is aggravated by standing for long periods. It
is important to remember that limiting fluid intake is not the key to preventing edema. You should drink
two litres of fluid daily - getting enough fluids is important to provide for the expanding blood volume
that carries oxygen and nutrients to your baby. You should also reduce your intake of tea and coffee
as they are diuretics and cause you to urinate more frequently than normal. Raising your legs whilst
sleeping and wearing certain types of stockings that enhance blood circulation will help.


Can I continue to smoke or drink alcohol?
Smoking is associated with adverse effects on both you and your baby. It may cause an increased
risk of miscarriages and ectopic pregnancies, placental bleeding as well as low birth weight babies
and premature births. There is also a long-term relationship with decreased intellectual development
of the babies and increased risk of Sudden Infant Death Syndrome. You should therefore try to stop
or cut down on your smoking as it is the commonest preventable risk factor.


In the case of alcohol, there are no safe limits. Consumption of 15 units (1 unit = 1 small glass of
wine) or more per week has been associated with a reduction in birth weight whilst consumption of 20
units or more per week has been associated with intellectual impairment in children and fetal
anomaly. Therefore, it is recommended that women should be careful about alcohol consumption in
pregnancy. The Centres for Disease Control (CDC) recommends that women should avoid alcohol
during pregnancy and the pre-conceptional period.


Should I breastfeed?
Breastfeeding has wonderful benefits - not only for your baby's health and development but also for
nurturing the emotional bond between the two of you. Breast milk contains all the necessary nutrients
as well as antibodies for protecting your baby during the first month when he is unable to produce his
own.


In addition, it has been shown that breastfeeding helps to reduce the chance of becoming prone to
allergies, eczema or asthma, especially if there is a strong family history of these conditions.


KKH's Lactation Clinic is managed by experienced lactation consultants who provide advice on
breastfeeding or management of problems like sore or cracked nipples. For an appointment with a
Lactation Consultant, please call 6293 4044 (you will be first put through to an operator).


What should I do about taking medications?
You should discuss with your GP or obstetrician before taking any medication especially during the
first few months of pregnancy when the baby's organs are developing. This is because certain drugs
are known to affect the development of the baby. If you are on long-term medication, the ideal time to
review them is when you're planning to try for a baby. Stopping medication that would otherwise be
necessary for your well-being may put you and your baby at risk.


Can I continue to exercise?
If you are already attending an exercise class or sports session, inform your instructor that you are
pregnant. If you are not exercising regularly, you may consider beginning a low impact sport, but
should not exert yourself beyond your non-pregnant limits. Exercising not only energises you but also
has emotional benefits. Twenty minutes three times a week provides you with sufficient exercise.


Swimming and walking are two of the best activities. Remember to spend time warming up before
starting and to allow your body to cool down later after exercising. Foot exercises are helpful in
improving circulation and swollen ankles, whilst pelvic floor exercises also help to reduce the risk of
stress incontinence (urine leakage) after the birth. The use of saunas in pregnancy should be avoided
during pregnancy as dehydration may occur.


Is it safe to have sex?
There is no reason why pregnant women cannot have a fulfilling sex life. Sex in pregnancy, in most
patients, is safe. In fact, the pregnancy hormones may increase your libido. As your pregnancy
progresses, you may want to experiment with different positions to find one that is comfortable. If you
have suffered from any early bleeding, premature labour or have a low-lying placenta, it is wise to
consult your doctor who may suggest a period of abstinence.


Are there any workplace hazards?
Whilst most women can safely continue to work in pregnancy, certain jobs may require more caution.
Work considered hazardous include:

  • Dealing with substances like pesticides, insecticides and certain chemicals
  • Contact with radiation
  • Exposure to hydrocarbon solvents like dry-cleaning fluids, lead or mercury.

Can I travel whilst pregnant?
Commercial air travel poses no special risks to an uncomplicated pregnancy. Domestic travel is
usually permitted until 36 weeks gestation whereas international travel may be curtailed after the 32nd
week of pregnancy.


You should always carry documents stating your expected date of delivery. In view of the increased
risk of developing deep vein thrombosis (clots in the legs) in pregnancy, air travel should be kept to a
minimum. It is advisable to walk every half an hour during a smooth flight, to flex and extend the
ankles and to keep yourself well-hydrated.


Fluids should also be taken liberally because of the dehydration effects of the low humidity in aircraft
cabins. Certain conditions like severe anaemia (low blood count) or a low-lying placenta are relative
contraindications to flying. Unexpected events may also occur e.g. vaginal bleeding or labour. It is
important to seek medical assessment before air travel.


What are some of the common ailments of pregnancy?
Most of these problems are caused by hormonal changes and the extra strain your body is under.
They are usually temporary, cause minor discomfort and can be treated easily.


Backache
Avoid lifting heavy weights and wearing high-heeled shoes. Observe proper body posture while sitting
and carrying things. Support your back with a cushion. Where possible, kneeling on all fours and
rocking from side to side can relieve the pressure on the back. Simple analgesia like paracetamol can
be safely taken during pregnancy. A physiotherapist can provide helpful tips on proper posture.


Heartburn/Indigestion/Bloatedness
Heartburn is a burning sensation in the chest or regurgitation of acid in the throat. Bloatedness is due
to the hormonal effects of pregnancy, Eat small frequent meals and avoid spicy or fatty foods. Acidic
foods e.g.: citrus drinks and coffee may aggravate the problem. Avoid lying down immediately after a
meal and prop yourself up with pillows at night to reduce this problem. Consult your doctor if the
syptoms are bothersome as certain medications may help in easing the discomfort.


Water retention
It is important to remember that limiting fluid intake is not the key to preventing edema. You should
drink two litres of fluid daily and should limit your intake of tea and coffee. Some women also feel
better when they eat less salt and monosodium glutamate. Avoid standing for long periods of time and
raise your legs whenever possible. Wearing well-fitted compression stockings may help as well.


Constipation
Ensure a high fibre diet and drink plenty of water. Regular exercise will encourage movement of the
gut and prevent constipation.


Morning Sickness
This is especially common in the first few months of pregnancy. Unlike its coined term, it can occur at
any time of the day but fortunately it usually disappears by 14 weeks. Increase the frequency of your
meals but with smaller portions of food at each time - a piece of dry toast, a cracker or a biscuit often
helps to settle the stomach. Alternatively take foods with ginger.


Light-headedness
The blood pressure is lower in pregnancy due to dilation of your blood vessels. Avoid long periods of
standing, rapid and sudden changes in posture and prolonged hot baths. Keep yourself well hydrated.
If your red cell counts are low in pregnancy (anaemia), you might need iron supplementation. Consult
your doctor as further investigations or treatments may be required.


Piles
These are dilated veins in your anus and can be painful, itchy, uncomfortable and cause bleeding in
your stools. This usually occurs in the later stages of pregnancy. Avoid constipation and eat a high
fibre diet with lots of water. Alternatively your doctor can prescribe suppositories and creams to ease
the symptoms.


Sleeplessness
This could be due to anxiety, heartburn or the need to urinate more often at night. A warm shower
before bedtime or relaxing music may help calm the nerves. In some ladies, they may feel more tired
than often and sleep more.


Stretchmarks/Striae
These are raised, pigmented marks on your breasts, abdomen, thighs or buttocks. Moisturizers or
cocoa butter may help. They may resolve after pregnancy and the colour may lighten but may be
permanent.


Tender Breasts
Wearing a good support bra may help. The size may increase as your pregnancy advances and a
second bra-fitting may be appropriate.


Vaginal discharge
Increased vaginal discharge is very common in pregnancy due to the hormonal changes.
Occasionally, it can be due to an infection which usually causes itch and a foul-smelling odour. This
can be easily treated with a cream or pessary. Do consult your doctor if you are experiencing any
symptoms.


Urinary Problems
This may include more frequent urination, leaking urine whilst laughing or sneezing or increased
tendency for urinary tract infections. These are due to the extra weight and pressure of your baby
pressing on your bladder and pelvic floor. Avoid holding your bladder for prolonged periods of time
and observe basic hygiene for caring of the lower genital region. For incontinence, regular pelvic floor
exercises during and after pregnancy will help. If you develop pain on urination, blood in the urine or
pain in the lower abdominal region, you might have a urinary tract infection and should seek treatment
for a course of antibiotics.


Vaginal Secretions
During pregnancy, there will be an increase in vaginal secretions and is normally white and clear.
Consult your doctor if it is associated with itch, bleeding, a foul-smell or if you suspect you have
broken your water-bag.


Varicose Veins
These distended veins around your calves, back, legs, thighs or even your vagina, which may be
reduced by avoiding prolonged periods of standing and exercising regularly. If you develop pain in
only one calf, with associated swelling and redness, do consult your doctor.


What are the warning symptoms of adverse events in pregnancy?


Pre-eclampsia
What is pre-eclampsia?
This is the commonest antenatal complication affecting one in 10 pregnancies and one in five first
pregnancies. In some cases, the illness may progress to severely affect both the mother and the
fetus.


What are the symptoms?
The main symptoms include headaches, feeling dizzy, nausea and vomiting, blurred or double vision,
generally feeling unwell and pain in the upper abdomen. Unfortunately pre-eclampsia can also
develop without any obvious signs. It is therefore vital to attend the clinics regularly.


Preterm labour
Why is preterm labour significant?
Babies born premature are at risk of several complications especially breathing problems. Women in
preterm labour may benefit from a steroid injection. This will promote maturation of the baby's lungs
should the delivery be inevitable. Other medications to reduce the severity of uterine contractions and
to treat the cause of the pre-term labour e.g. infections may also be used.


What are the symptoms of labour?
Labour begins with regular, painful uterine contractions or tightening of the abdomen, 'bloody show'
(blood-stained mucus) or 'breaking of your waters' (rupture of your membranes). This usually occurs
at term, after 37 weeks of pregnancy. Preterm labour occurs when these signs are present before 37
weeks.


Vaginal bleeding
Why is it significant?
Early pregnancy
Light spotting or bleeding in early pregnancy may indicate the possibility of a miscarriage or ectopic
pregnancy (pregnancy implanted outside the womb). However, the commonest reason for bleeding is
due to implantation which occurs when the embryo is attached to the womb at –four to five weeks of
pregnancy. Implantation bleeding, if isolated and associated with a normally placed healthy embryo,
does not have any impact on the development of the fetus.


Late pregnancy
Light bleeding with blood-stained mucus in the month before your baby is due could be a 'show' -- a
sign that you may go into labour within the next few days or week. Bright red bleeding which may
come and go could be from a low-lying placenta or from mild placental separation.


Reduced fetal movements
What should I do?
Babies are most active when you are at rest. This is because you are now more aware of their
movements. Hence you will notice frequent movements in the evening or at bedtime. There should be
at least 10 "kicks" over a 12-hour period. Conversely an active baby is reassuring and excessive
movements are not cause for worry.


Why is it important?
You should be concerned and seek help if there is persistent decrease in fetal movements. Your
doctor will examine you and may perform additional tests like a cardiotocography (which monitors the
fetal heart rate) and ultrasound. Stillbirths (babies who die in the womb before they can be delivered)
may be preceded by decreased fetal movements.


Prelabour rupture of membranes
What is it?
Normally the water-bag is ruptured (either spontaneously or by your obstetrician) when labour begins.
Prolonged rupture of your water-bag before the onset of labour may be associated with increased
risks to your baby. Complications include infection or prolapse of the umbilical cord through the cervix.


What are the symptoms?
If you feel a sudden gush or continuous flow of clear fluid from the vagina, consult your obstetrician.


Where can I seek help should problems arise during pregnancy?

Go to your GP
Your nearest family physician should be able to advise you on minor medical problems such as flu,
intestinal upset or rashes in pregnancy.


O&G 24-hour Clinic, Basement 1, KK Women's and Children's Hospital
This clinic is available for early pregnancy (below 22 weeks of pregnancy) as well as postnatal (after
delivery) consultations.


Delivery Suite - Triage Room, Level 2, KK Women's and Children's Hospital
All pregnancies beyond 22 weeks of gestation will be assessed here including those presenting in
labour. The decision for admission to the hospital will be made by our Senior Medical Officers in
consultation with the specialists-in-charge.


This featured article is contributed by the Department of Obstetrics and Gynaecology, KK
Women's and Children's Hospital. To read more please visit www.kkh.com.sg/HealthPedia

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