First trimester Workup & algorithms
Dr. Abha Majumdar
Pre-conception counseling allows
Ideal pre natal care should start before conception
AIMS OF ANTENATAL CARE
Monitoring of progress of pregnancy
Early detection of deviation from normal
Institution of corrective measures
Guidance & preparation of for delivery
Antenatal care starts with confirmation of pregnancy
4 Steps To ANC
AN OBSTETRIC HISTORY SHOULD INCLUDE
- Current pregnancy details.
- Past obstetric history.
- Past gynecological history.
- Past medical and surgical history.
- Drug history and allergies.
- Family history-especially multiple pregnancy, diabetes, hypertension, chromosome or congenital malformations.
- Social history.
- History of systemic review.
- Case summary.
Investigations
Basic
Hemoglobin PCV
Urine routine
Blood sugar
Blood group Rh
Advanced
Thyroid profile
HbsAg
HIV 1 &11
VDRL
Premium
Thalassemia screen
Anti HCV
Dual marker of 1st trimester
Pregnancy is a normal physiological process
EARLY SIGNS OF PREGNANCY
THAT YOU MUST BE AWARE OF
Dizziness
Tender Breasts
Fatigue and tiredness
Increased Sensitivity to smell
Nausea
Mood Swings
Frequent Urination
A Missed Period
Exercises
Exercises to avoid
Contact sports Sports with risk of falling Jumping bouncing Supine exercise Racquet Sports
Exercises to do
Brisk walking Aerobics Abdominal exercises Dancing Swimming Yoga
Benefits of exercises
Improves mood, aches and pains, blood circulation, heightened energy & lowers gestational diabetes.
Frequent meals
- Early morning 6.30-7.00am
- Breakfast 8.30-9.00am
- Mid mornimg 11-11.30am
- Lunch 1-1.30pm
- Evening snack 5-5.30pm
- Dinner 8-8.30pm
- Post dinner 9.30-10pm
Nausea and vomiting
Glucose drinks, aerated drinks, fruit juices, fried food, chat, spicy pickles & masala curries best avoided. Bland food like toasted bread, boiled eggs, paneer, cheese and ice-creams better tolerated.
Rest
Mid-day nap essential otherwise lack of sleep translates into feeling of tiredness all day.
Constipation
Common due to P4 effect on GI tract. Only bulk forming laxatives recommended. Cremaffin not good as may reduce absorption of essential vitamins.
Consume in moderation
Papaya
RIPE PAPAYA
Rich in vitamin c, antioxidants & other wholesome nutrients Excellent in heartburn & constipation.
Safe in first trimester
RAW PAPAYA
Contains latex may start contractions in late pregnancy Has pepsin & papain; may reduce growth of fetus.
Unsafe for pregnant women
Medication
Medication in first trimester in natural spontaneous conceptions
Folic acid
Yes
Progesterone supplementation
No
Travel While Pregnent
First Trimester tips
Loose-fitting clothes & comfortable flat shoes Avoid altitudes above 3,658 metres; Travellers’ diarrhoea can cause miscarriages in 1st trimester Stay away from activities that are too adventurous,
In a car :
- Seat belt a must
- Be comfortable, carry a little pillow, snacks and water
- For nausea ginger lozenges or crushed ginger
- Slow pace, break journey for a nap in a quiet place
In a plane :
- aisle seat
- carry snacks
