Follow the Baby's Growth With a Pregnancy Calendar

A pregnancy calendar is a useful guide which helps the expecting mother to understand the changes within her. The period of pregnancy is divided into three trimesters of three months each. During each of these trimesters, the fetus undergoes rapid changes till it is ready to be delivered.

Adequate Rest Is Essential

During the first and the third trimester, the mother is advised to take certain precautions for the safety of the fetus. For instance, she is advised against excessive traveling. Also, during the first trimester, when the fetus is vulnerable, she should avoid exposure to toxins like smoke and alcohol. Even inhaling second hand smoke can harm the fetus. With the help of a pregnancy calendar, the mother can get an approximate idea of the stage of her pregnancy. Once her pregnancy has been confirmed, she can note the date of her last menstrual period to learn about her expected due date of delivery. This date falls after the completion of 40 to 42 weeks of her last menstrual period or LMP. During the entire pregnancy time, the expecting mother experiences several changes as her fetus grows. Generally, all women experience a lot of fatigue when they are pregnant. Hence, it is advised to listen to the body's needs and take sufficient rest. Other common symptoms include morning sickness or nausea and a bloated feeling in the abdominal region. During early pregnancy, the abdomen does not grow in size. It is a good idea to lie on one side while sleeping and using a pillow to support the abdomen. Not only lying on the side gives comfort, but also improves blood circulation in the body.

Important To Consult An Experienced Gynecologist

A pregnancy calendar helps to understand the developmental stages of the fetus. The expecting mother can also get tips to handle the discomforting changes that she may be experiencing. Most women suffer nausea at the start of their pregnancy, but are relieved after the second or the third month. Once the pregnancy reaches its tenth week, the fetus is stronger and has a lesser chance to develop congenital deformities or undergo a miscarriage. By ten weeks, the fetus is about one and a half inches long. Most of its organs, like the kidney, the liver, the heart, and the brain are already formed and start growing rapidly. The baby may also start growing toenails and fine hair. Around this time, the expecting mother can also see the picture of her fetus through an ultrasound. The fetus starts moving its limbs within the womb, but due to its tiny size, the movements are too mild to be felt by the mother-to-be.

One can find a pregnancy calendar on websites which offer information for pregnant women. Such sites provide a weekly account of what to expect during the course of pregnancy. With the relevant information, an expecting mother is better prepared to handle and enjoy the course of her pregnancy.

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Vaginal Discharge - An Early Pregnancy Symptom

Most women are aware that morning sickness is the earliest pregnancy symptom. Another most obvious and conform indicator of pregnancy is thought to be the missed periods. However, some women are unaware that vaginal discharge is also a sign of early pregnancy. Read on to find the details.

The vaginal discharge that can be seen on the underwear or when you wipe off after urinating generally ranges in color. It varies from pinkish brown to milky white. The reason behind this vaginal discharge is the increase in estrogen level and increased flow of blood towards vagina. Sometime it seems that you are spotting especially if the discharge occurs around the days of menstrual cycles. Pinkish brown color is because of the blood that is left over from previous cycles and there is nothing alarming in it.

Every woman does not experience this type of discharge. So if this discharge is not noticed then it does not mean that the woman is not pregnant. There are chances that the woman is pregnant and do not have this sign of pregnancy. The sure way of determining your pregnancy is by visiting doctor.

Vaginal discharge is also termed mucus plug. This mucus plug blocks the cervical opening to protect the child from different infections. As the pregnancy progresses and the turns towards labor, the body expels the mucus plug as the cervix is dilated.

As long as this discharge is odorless and is not followed by itching or burning; it is only the indicator of pregnancy. However if the vaginal discharge is smelly and itchy it is better to consult gynecologist. The smelly discharge could be the indicator of sexually transmitted disease, some viral or bacterial infection.

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Molar Pregnancy Symptoms

Despite this type of pregnancy being unique and only a few experiencing it, It is still pregnancy. We are looking at it like something that will have all unique and different symptoms from those of a normal pregnancy. If, you are having a question on the symptoms of this pregnancy first you will have to know that It that same symptoms like that of a normal pregnancy. Many are the symptoms of the normal pregnancy like a missed menstrual period, breast tenderness, fatigue, increased urination, morning sickness etc.

Apart from having the same symptoms it has also unique symptoms that are distinguishing it from normal pregnancy. These symptoms will enable you to notice that is not an ordinary pregnancy. Below are some of the some of these symptoms there are many but below a few most common:

1. Vaginal bleeding something like you are attending your monthly period. If this happens while you are pregnant it becomes a symptom.

2. Vaginal discharge of tissue that is shaped like grapes apart from bleeding you will also experience this vaginal discharge. This is the most characteristic symptom of a molar pregnancy.

3. A uterus that is abnormally large for the length of the pregnancy can be detected physically or when you go for test. It not so easy for people that have not taken an ultrasound as they might think they are having twins.

4. Severe nausea and vomiting it is when these signs have gone beyond the expected normal levels that will be a sign of molar pregnancy. Remember even in normal pregnancy you may experience this but not very severe.

5. Signs of hyperthyroidism, such as fatigue, weight loss, increased heart rate, heat intolerance, sweating, irritability, anxiety, muscle weakness, and thyroid enlargement.

6. Pelvic discomfort this happens to many that going through this period.

Apart from these symptoms there are many more that you can also experience depending on your body however the above are the most common symptoms.

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3 Earliest Pregnancy Symptoms Help to Know Answer of "Am I Pregnant?"

Is there any earliest pregnancy symptom that can help the woman to know the answer of "am I pregnant?" even before the lab or home test? If you have the same query in your mind then you must go through the following passages to find the answer.

Certainly there are few earliest possible symptoms of pregnancy. These symptoms help the woman to determine her pregnancy even before the pregnancy test. There are women who are able to detect these earliest pregnancy symptoms, the moment conception takes place. It is because they have a fair understanding of these symptoms.

Following are the earliest pregnancy symptoms. These signs of pregnancy enable the woman to spot her pregnancy before she misses her periods.

Basal Body Temperature: There are many women who know well that the basal temperature of the body increases at the time of ovulation. But only few of them are aware, that if the body temperature stays elevated, then this could be a possible sign of pregnancy. For careful monitoring of basal body temperature the woman only requires a cheap thermometer. This thermometer enables the woman to detect even minute temperature changes.

Enlarged Breasts: The level of hormones changes drastically in the early pregnancy. The body reacts to thee changes in hormonal levels by giving different symptoms. Body is not ready for these drastic changes in hormonal levels. The most evident change as a result of increased hormones takes place in the shape and size of breasts. Soon after conception there is a feeling of tenderness or fullness. Sometimes this tenderness fades away as the body gets acquainted to new levels of hormones.

Fatigue: Another earliest pregnancy symptom is lack of energy. At times it becomes hard to distinguish between general exhaustion and pregnancy related fatigue. However health professionals believe that fatigue is also linked to new levels of hormones. These fatigue feelings become normal when the body regulates itself to new hormonal level.

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Symptom of Pregnancy – the Early Signs

Apurva Shree asked:
Pregnancy is a most unique period in a woman’s life. While bringing great joy, it can also be a very confusing time for most women as they try to figure out whether they are really pregnant. Of course, it is very much possible to confuse the early signs of pregnancy with symptoms of some other illness. At the same time, there are some symptoms of pregnancy that will confirm the onset of pregnancy.

Pregnancy Symptoms

One of the commonest early signs of pregnancy is a missed period. The confusion sets in because a missed period can also be due to stress, illness, and fluctuations in weight. Cessation of oral contraceptives, and a polycystic ovary syndrome also lead to a missed period.

Changes in the size and feel of the ****** are an early sign of pregnancy. The ******* begin to enlarge and most women experience greater tenderness of the ****** along with a tingling sensation. It may well be that this pregnancy symptom disappears after some time.

Nausea and vomiting is also an early sign of pregnancy and amongst the most unwelcome symptoms of pregnancy. It can occur as early as two weeks after conception and tends to taper off by the end of the third month of the pregnancy.

While many women experience tiredness, this can be due to other reasons as well and cannot by itself be considered a pregnancy symptom.

The darkening of the areola is also indicative of pregnancy. It remains for the entire tenure of the pregnancy and is one of the surest symptoms of pregnancy.

Frequent ********* as early as two weeks after conception is also indicative of pregnancy. This occurs due to higher levels of progesterone and the uterus rising up to the abdomen, which in turn exerts pressure on the bladder. The bladder then feels full, even though there may not be a need to urinate. Some women are also affected by constipation, which can also be quite annoying.

Another symptom of pregnancy is women feeling queasy about certain foods while experiencing an almost uncontrollable craving for other foods.

Weekly Pregnancy Calendar

Pregnancy calendars are a handy way of keeping a record of the changes a woman’s body and the fetus undergo at specific intervals during the course of the pregnancy. A weekly pregnancy calendar does this on a weekly basis.

The calculation typically begins from the last date of last period and includes the due date of birth, which is generally forty weeks from the first day of the last period. It is a useful tool to monitor the health of the mother and the baby.

First-time mothers can easily confuse pregnancy symptoms with symptoms of other illness. However, awareness of early signs of pregnancy will help you in identifying these symptoms in the initial stages. A weekly pregnancy calendar is a useful aide to monitor the heath of the mother and the baby.

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Pregnancy Symptom : The Classic Symptoms

Saurabh Jain asked:
The first reaction to early sign of pregnancy is disbelief, joy followed by a feeling of uncertainty. A visit to the doctor and a blood test is the only way to confirm your pregnancy. Early pregnancy tests are very reliable and even show the accurate results of a 2-week-old embryo. Before the visit to a doctor for the confirmation of pregnancy, it is very important to watch out for pregnancy symptoms. The precautions taken during early sign of pregnancy is very important for embryos health and well being. Some of the most recognizable signs of pregnancy are as follows.

Classic pregnancy symptoms

These pregnancy symptoms appear soon after fertilization, within 8-10 days after conception. Some of the pregnancy symptoms stay with you for the entire period of gestation, while some pregnancy symptoms disappear as the pregnancy advances. They stop troubling you as your body starts getting used to change in hormones and settles to the imminent body changes. A few temporary early signs of pregnancy are:

Missed periods or less bleeding at the onset of periods. The absence of periods during the duration of pregnancy is because now the uterine lining need not be shed but used for implantation of the embryo.

Lower abdominal cramps, which begin soon after the implantation of embryo, disappear within a week or two. Headaches caused by rising levels of hormones in the first few days of pregnancy too disappear once the body accepts the change in hormonal levels.

The pregnancy symptoms that last the entire period of pregnancy are:

Nausea and vomiting are the early signs of pregnancy starting in the second week itself. The degree in which you feel sick varies from full fledged to none as the pregnancy advances. It is fairly controlled during the third trimester, making you feel more relaxed and happy.

Tender and swollen ******* appear soon after conception and stays with you till the entire period. It is the natures way to make the ****** ready for babys breastfeeding. In the last trimester the ******* secrete a liquid called colostrums, which provides immunity to the baby.

Enlarging and darkening of areola is the first sign of pregnancy, and lasts throughout.

Frequent ********* and constipation is early sign of pregnancy and increases with the advancing pregnancy due to the pressure of the growing embryo on the surrounding body organs.

Exhaustion and tiredness occurs from initial stages of pregnancy and stay the entire duration of the gestation.

Food cravings for a particular type of food are still an unsolved mystery. Some doctors feel this is the way the body acquires the adequate minerals required by the growing embryo. This pregnancy symptom is an early sign of pregnancy and stays on till the end.

Increased sense of smell and taste too varies in all stages of pregnancy.

If you experience these pregnancy symptoms then take care of your health. Avoid harmful products; start taking balanced diet and some extra folic acid for happy and healthy pregnancy.

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Your Perfect Pregnancy Diet

Eating the right food during pregnancy is very important. When you are pregnant, you have to take care of two people - you and your baby. You have to eat for two. It doesn't mean that you just have to eat double the quantity you actually eat. It actually means that you have to be more careful about your eating habits because your baby is involved here. Your pregnancy diet will determine how healthy your baby is going to be. If you eat nutritional diet, it will result in healthier babies. On the other hand, unhealthy eating habits may result in babies with various mental and physical issues - you definitely don't like that. So, educate yourself now about the right eating habit during pregnancy.

Nutritional Diet

You have to practice a nutritional diet. It is very important for you to understand that your baby is going to take nutrients from the food you are eating. The baby does it through the umbilical cord. Some of the nutrients that are essential for you at this stage include calcium, zink, iron, and folic acid. However, it does not mean that other nutrients are not necessary - it's just that the mentioned ones are more important. When you are in the first trimester, your pregnancy diet must include vitamin B9 and folic acid. Folic acid plays a very important role in development of the baby, especially its nervous system.

So, you must have at least 400 microgram supplement of folic acid everyday. Besides that, you should also focus on foods that are rich in folic acid, such as fruit juices, beans, and green vegetables. Eat a lot of these foods on a daily basis. Such nutritional diet will ensure that no congenital malfunction occur during the baby's development.

Foods Rich In Iron

When it comes to pregnancy diet, foods rich in iron are also important. It makes the process of blood production in the baby's body easier. This way, when you eat foods rich in iron, you actually help in making your baby healthier. However, in order to absorb iron quickly in your body, you may also need to take a vitamin C supplement or the help of an ascorbic acid. Some iron-rich foods include strawberries, green vegetables, and whole meal bread.

Zinc And Calcium

The perfect pregnancy diet should also include a steady intake of calcium and zinc. These nutrients make the development procedure of the fetus much smoother. Milk can be a great source for zinc and calcium. In fact, milk is also a great source for iron. So, you are strongly recommended to drink milk regularly while you are pregnant.

You will have to make sure that you are eating any one thing too much. The basic idea is to practice a well-balanced diet. You have to eat balanced portions from different food groups, including dairy products, fats, carbohydrates, meat, poultry, fish, vegetables, and fruits. Most importantly, when it comes to following a perfect pregnancy diet, you must follow your doctor's advice strictly.

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Foods to Eat When Pregnant & Pregnancy Nutrition

Congratulations! You are now in the family way. As you relax and realize that you are carrying a miracle of life, you will begin to get pre-occupied with a million-and-one worries and concerns about things that need doing. First things first; you should visit your doctor the moment you realize that you are pregnant. That way, he or she will guide you in dealing with more important things like pregnancy nutrition. Knowing the foods to eat when pregnant is a major factor in ensuring you and your baby's health as you go to full term.

Proper nutrition is essential in determining the future well-being of your child. By understanding the right foods to eat when pregnant and avoiding foods that pose major risk factors, you reduce the possibility of birth defects, low birth weight and mortality. In addition to maintaining the baby as well as the mother's health, pregnancy nutrition enables the pregnant woman to have enough food nutrients and energy to cope with the changes in her body and provide for the developmental needs of the baby as it reaches full term. Hence, a pregnant woman who eats well can avoid all known risks of pregnancy complications and ensure the delivery of a perfectly normal and healthy baby.

There are a few requirements in maintaining a well balanced pregnancy diet. Having foods that are high in vitamins, minerals, proteins, carbohydrates, fats and folate will deliver immense health benefits. Usually, proper pregnancy nutrition requires women to eat foods from five main food groups daily; Bread, cereals and grain group, vegetable group, fruits, meat, poultry, beans, eggs and nuts group, and the dairy group.

One of the best strategies in maintaining proper pregnancy nutrition is consuming a variety of foods. A pregnant women needs to consume an extra 10 grams of protein per day to support normal fetus growth and development. Protein is a food nutrient that is seldom included in pregnancy supplements so you need to get it from meat, poultry, beans, eggs, nuts and dairy products.

Folate is an vital element for the pregnant woman and the following foods need to be on the top of her list of foods to eat when pregnant; Orange juice, spinach, fortified breakfast cereals, breads and pastas. Folate plays a crucial role in preventing neural tube defects that may occur early in the pregnancy. You need to get 600 mcg of folate daily to ensure your baby's healthy neural tube and brain development. Your doctor will also prescribe folic acid to ensure adequate daily intake.

Calcium is essential in developing healthy bones and teeth in the baby and in maintaining strong bones to support your body as it undergo certain changes. Broccoli, almonds, okra, tofu, milk and milk products are calcium-rich foods.

Constipation is a regular health complaint during pregnancy. This explains the necessity of integrating fiber into proper pregnancy nutrition. Whole grain breads and cereals, nuts, seeds and fruits are helpful in this regard.

The essential foods to eat when pregnant should also contain nuts, salmon, avocados, olive oil and sunflower oil. All these foods contain healthy fats that ensure central nervous system development in the fetus.

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Pregnancy Nutrition Advice For Mother and Child

If you happen to be expecting a baby or if you are looking into pregnancy tips, then one thing you are going to want to give priority to is pregnancy nutrition. After all, this defenseless little one is relying on YOU to give it all of the vitamins and minerals that it needs to grow and function normally.

You will be able to help avoid birth defects or having a premature baby by looking after your own pregnancy diet because, in turn, you are actually looking after your baby's health and well-being. You must consume just the right amount of vitamins, minerals, and calories in order for your baby to grow.

Even though you may be taking prenatal vitamins, you need to have a good handle about other things that you should be eating in order to ensure your pregnancy nutrition is up to scratch. Yes, it is true that your doctor will prescribe prenatal vitamins but there is even more that you should be doing to ensure that you have a perfect, little "bundle of joy".

You must ask yourself the following questions:

Is it necessary to take iron supplements? What vitamins need to be taken on a daily basis? What foods should I avoid? If I am a diabetic, how can I get enough sugars to my baby? Why is each trimester different in terms of pregnancy nutrition?

Naturally you want the best for your baby, and pregnancy nutrition has to be on top of your list. That is why you add some sliced fruit to your fortified cereal in the morning, put some extra veggies in your favorite recipes, and eat some delicious yogurt for dessert.

However, do you know what foods to avoid on your pregnancy diet? Seafood can be a very good source of iron and protein as well as the omega-3 fatty acids. This can help promote the development of your baby's brain. Research has shown that if you skimp on seafood during your pregnancy, this may help contribute to poor verbal skills. It may also lead to behavioral problems and other developmental issues as the child grows.

Some shellfish and fish should not be included in pregnancy nutrition as they may contain dangerous levels of mercury. If you happen to consume too much mercury, this may damage the nervous system of your developing baby. The older and bigger the fish, the more mercury it is liable to contain. It is advisable that pregnant women avoid eating these fish:

King mackerel, Swordfish, Shark, Tilefish.

Then, what kinds of fish may be consumed as part of your pregnancy nutrition diet? The EPA as well as the FDA says that pregnant women will be able to eat up to 12 ounces a week of the following:

Salmon, Catfish, Shrimp, Cod, Pollock, Canned light tuna.

During pregnancy, you may experience changes in your circulation and metabolism. This may increase the risk of getting bacterial food poisoning. Since you are pregnant, your reaction may be more severe than if you were not. Hopefully, this article on pregnancy nutrition has made you realize how very important pregnancy nutrition is. Remember, you control the destiny of your child.

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Pregnancy Diet – Watch your Nutrition

Pregnancy is not only most creative and fulfilling phase of womanhood but it teaches you to be more responsible and caring towards yourself particularly with respect to pregnancy diet and nutrition. In the pregnancy period, your baby, whom you are creating with your flesh and blood, is still very much part of your body and for that you need more nutrition intake. During pregnancy, nutritional needs are increased, both to support the rapid growing fetus and to supplement the needs of your changing body structure.

Plan your pregnancy diet in such a way that you are the only supply line for your unborn baby’s nutrition needs. Your eating habits will decide your baby’s health and well-being. Poor eating or rather unhealthy food habits can adversely affect your pregnancy diet and nutrition and result in conditions like anemia, pre-eclampsia, mood swings, fatigue, leg cramps, constipation, etc.

Pregnancy: Celebrate It With Healthy Pregnancy Diet

During pregnancy, every bite counts. Whatever an expectant mother eats or hates to eat, affects her child. According to a recent research, besides physical development, intelligence of a child and his/her mental faculty depends a lot on the diet and nutrition of the mother during pregnancy.

In the first trimester of pregnancy, one does not need extra calories per se in pregnancy diet. However, one needs to have lots of high protein, calcium, vitamins such as Vitamins B12, B6, vitamin D iron, zinc and folic acid (it has been proved after myriad researches that even a simple tablet of folic acid prevents severe neurological- brain and spinal cord disorders). In addition, minerals, essential fatty acids and substantial calories are all-important for the fetus’ all-round development and therefore should be essential components of pregnancy diet and nutrition plan.

As the pregnancy period progresses, one must start eating more of proteins in the pregnancy diet. A pregnant woman needs approximately 300 calories more than normal during last 6 months of pregnancy. In first three months of pregnancy, your weight gain should be 3-5 pounds in per month but in last 6 months, you should not gain more than 3 pounds per month. Your pregnancy diet and nutrition chart should be designed in accordance with these acceptable weight gain goals.

Foods To Include In Pregnancy Diet

You should include fresh, light, wholesome, high fiber foods in your pregnancy diet in form of porridge (minerals and natural fiber); dairy (calcium); red vegetables like carrot and tomatoes (carotene); red and orange fruits like apples and oranges (vitamin B complex). Walnuts, almonds and raisins (vitamin and minerals); leafy vegetables like cabbage, spinach, broccoli (calcium and iron); brown rice, jaggery, lotus stem (iron); sprouts, lentil and pulses (protein), curd, buttermilk, paneer and of course plenty of milk (calcium) are important ingredients of pregnancy diet.

During the pregnancy period, eat five small meals a day instead of three heavy meals. Also, reduce your intake of fat, sugar and salt. Do not indulge in overeating during pregnancy because if you eat too much you will feel uncomfortable.

One basic mantra of staying healthy is to drink lots of water (will prevent dehydration and wash out the toxins of body) as soon as you wake up in the morning and after your afternoon nap It helps clean your digestive system too. You might be scared you would vomit if you drink more water, when you have nausea, which is normal in pregnancy, but the fact is, water helps to flush out the toxins from your body.

During pregnancy, strictly avoid junk food because they just give you empty calories (and extra pounds) without the nutritional benefits of healthier foods also avoid caffeine and alcohol fats, oily food, additives and unpasteurized food.

Besides healthy eating and maintaining a healthy pregnancy diet and nutrition plan in consultation with your doctor, you should do yoga and other light exercises under expert medical advice. Last but not the least, try to remain stress free, meditate and in this period of your pregnancy increase your connectivity with the Almighty. This will definitely shower you and your baby with positive energy.

So, be cool, relax, and celebrate your pregnancy and be a responsible and caring mom-to-be with balanced pregnancy diet and nutrition.

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Twin Pregnancy

Pregnancy as every one knows commonly terminates with the birth of a single child. However, while triplets are extremely rare, one in ninety pregnant women carries twins. Twins are most frequently born to parents whose ancestors have established this tendency but they are now becoming more common especially because of the growing use of infertility treatments. Reproductive technologies that assist with natural fertilization such as in vitro fertilization (IVF) often use ovulation-stimulating medications to produce multiple eggs which are then fertilized and returned to the uterus to develop.

Of course, that does not explain the cause of twins, which in reality can result from either of two circumstances. More commonly their origin depends upon the ripening of two eggs at about the same time and the fertilization of both by two different spermatozoa. The children, in this instance known as double ovum twins, or fraternal twins may be of the same sex or not. On the other hand, single ovum, or identical, twins are always of the same sex; this follows, when one egg and just one spermatozoon are concerned. The incident permitting identical twins to develop from a solitary ovum must occur soon after fertilization when the embryo splits in two. One third of twins born are identical, of the same sex and look almost completely alike as they will share the same genetic makeup

During the first trimester your 12 week scan ultrasound testing will show whether you have a twin pregnancy. The sonographer (medical professionals who operate the equipment) can even identify whether you are carrying identical or fraternal twins by measuring the thickness of the membranes which separate the two amniotic sacs (the sac in which the fetus develops) in your uterus.

The presence of a multiple pregnancy can be recognized during the latter months of pregnancy when your doctor may detect two separate fetal heartbeats, at other times, during prenatal tests, abnormally high levels of hCG, (human chorionic gonadotropin) a hormone produced by the embryo soon after conception, will be found. Although there can be other reasons for testing rates of hCG in most cases higher levels may well lead your physician to expect a multiple pregnancy in your case.

A twin pregnancy is generally regarded by the medical profession as carrying a higher risk than single pregnancies; that of course does not necessarily mean that you are liable to experience any problems. Most women with twin pregnancies will complete their confinement without problems and will deliver two healthy babies.

As with any pregnancy however there are always risks of problems arising now and then. The best advice you can get is to take care of yourself, attend all your antenatal appointments (even if you feel fine and don't think you need them!), ask questions, voice any concerns you may have and follow any advice from your GP or midwife. Don't put off seeing a doctor if you experience any unexpected symptoms and if you are not happy with your care ask to be referred to the consultant who specialises in multiple births at your local hospital.

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Single Pregnancy versus Multiple Pregnancy

Pregnancy is a blessed event. When a multiple pregnancy is discovered, it can be even more exciting, although it is nerve-wracking at the same time. What are some things that make a multiple pregnancy different from a single pregnancy, besides the obvious fact that more than one baby will be born?

First, the financial implications are tremendous. There are two, or more, of everything that must be purchased. Finances aside, multiple pregnancy can take a toll on your sanity. Two babies equals double the crying and double the sleepless nights.

Two cribs, two strollers, and two sets of clothes. Also, since every baby is unique, each will have its own special needs. For example, each child might have different schedules to be changed. Each might not want to eat at the same time. When they do eat, they may not eat the same foods.

One might take to breastfeeding while the other will only take a bottle. Then there are diapers and baby formula. These can be expensive for one child. Multiply by two or more, and you have a tremendous expense that adds up quickly.

Medically, multiple pregnancy is automatically considered a "high risk" pregnancy. Keep in mind, however, that most women endure a multiple pregnancy with no adverse complications. Normal pregnancy ailments such as mood swings and back pain are exacerbated, but in general, it's nothing worse than that.

Outside of the financial implications, two or more infants can test the patience of any mother. Regardless of whether you go through a single pregnancy or a multiple pregnancy, you will get your share of sleeplessness and crying. Although you are subjected to double the crying and sleepless nights, there can be an advantage. If a multiple pregnancy signals the end of your child-bearing days, you will only have to go through this ordeal just once.

Watching your nutritional intake is a must with multiple pregnancy. You have to eat more, but at the same time, not gain excessive weight. It's a delicate balancing act that needs to be discussed with your doctor.

After a couple of years, it will all be a pleasant memory. Contrast this to the single pregnancy of a mother who will have multiple children. She will go through the ordeal with the first child, and then again when the second is born. Having a multiple pregnancy also means that you will give birth just once during one hospital visit.

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Multiple Pregnancy

1 Introduction

Multiple pregnancy poses particular problems for women, their infants, and for their caregivers. Women are likely to experience the common, unpleasant symptoms of pregnancy, such as heartburn, backache, hemorrhoids, difficulty walking, and tiredness to a greater degree than women with a singleton pregnancy. They are more likely to suffer from anemia, hypertension, pre-eclampsia, preterm labor, and operative delivery. The increased risks to the babies include congenital malformations, monochorionicity (both babies sharing one placenta), poor fetal growth, preterm birth, and perinatal death. For the survivors, in the long term there is a greater risk of cerebral palsy.

2 Prenatal care

A wide range of options for regular antenatal attendance are practised, ranging from modified shared care between obstetrician and general practitioner to weekly visits from the 20th week of gestation onwards. There is no evidence to suggest that one pattern of prenatal care is better than another, because this important research question has never been properly addressed. Regular prenatal visits permit screening for hypertension and pre-eclampsia by careful determination of blood pressure, and, if elevated, checking for proteinuria. Care for women with a multiple pregnancy who develop hypertension may be particularly important, and should follow current treatment recommendations.

2.1 Advice and support

Women with a multiple pregnancy need advice and support from caregivers to help them deal with the particular problems of multiple pregnancy and with the common, unpleasant symptoms of pregnancy, such as hemorrhoids, heartburn, and backache (see Chapter 13). They may be especially anxious about the pregnancy, the birth, and their ability to cope with the practical and financial demands of more than one new baby. Assisting women to find support, such as a special antenatal class for women with a multiple pregnancy or referring them to a multiple-birth support group, may help.

2.2 Nutrition

Fetal demands for iron and folate are increased in multiple pregnancy and anemia is reported more frequently than in singleton pregnancies. Routine iron and folate supplementation is often advised from the beginning of the second trimester, although this has not been shown to improve the clinical outcome of the pregnancy.



2.3 Ultrasound

If routine ultrasonography is not carried out, an ultrasound examination is indicated when multiple pregnancy is suspected. Routine early ultrasonography results in earlier detection of multiple pregnancies, the detection of mono-amniotic pregnancies (with greater risk), and the detection of some unsuspected congenital abnormalities. Earlier detection of multiple pregnancy has not been shown to improve fetal outcome.

The risk of neural tube defects, cardiac anomalies, and bowel atresias, have all been reported to be increased in twin pregnancies. Conjoined twins and twin reversed arterial perfusion sequence are rare anomalies that are found exclusively in multiple pregnancies. Early diagnosis of fetal anomaly enables appropriate counseling as to the care options available.

The prediction of amnionicity (number of amniotic sacs) and chorionicity (separate or joined placentas) by first-trimester ultrasound is possible, though its accuracy and the relevance to pregnancy outcome remains to be determined. In theory at least, knowledge of amnionicity and chorionicity may be helpful in a number of ways, such as in the differentiation of twin-to-twin transfusion syndrome from a twin pregnancy complicated by intra-uterine growth restriction, in management after a single fetal death, or where one of the twins has a major congenital malformation and selective termination is considered.

If twin-to-twin transfusion syndrome develops, several therapeutic options have been advocated. These include: non-steroidal anti-inflammatory drugs, repeated therapeutic amniocenteses, and techniques that interrupt the pathological placental circulation. The results of controlled trials of these therapies are awaited, although there has been minimal evidence to date that any of these improve infant outcome.

Poor fetal growth of one or more babies is a risk in a multiple pregnancy. No adequately controlled data are available on the value of regular ultrasound or umbilical artery Doppler for assessing fetal growth and well-being in multiple pregnancy.

3 Preterm birth

Preterm birth presents the greatest threat to infant survival. Counseling as to the signs and symptoms of preterm labor with advice to present to the hospital if they occur, together with a written information sheet, may be of value, although this approach has not been subjected to a controlled evaluation.

Prediction of preterm birth is difficult. Cervical assessment by digital examination or by ultrasonography has been reported to provide useful prediction of the risk of preterm birth.

How frequent these assessments should be made is uncertain, and whether they are more beneficial than harmful is unknown.

Cervical fibronectin may prove to be useful in predicting which women will give birth preterm, although the main strength lies in its negative predictive value. Whether the measurement of fibronectin will be useful clinically to improve pregnancy outcome remains to be established by controlled trials.

Several prenatal treatments have been used in attempts to reduce the risk of preterm birth and its sequelae in women with multiple pregnancy. These include cervical cerclage, beta-mimetic agents, home uterine-activity monitoring, and hospitalization for bed rest. All have been evaluated by controlled trials but, to date, none have proven to be of value in reducing the risk of preterm birth.

3.1 Cervical cerclage

In normal pregnancy, the uterine cervix is thought to assume a sphincter-like function to retain the contents of the uterus. A congenital or traumatically-acquired weakness of the cervix, or the unusual physiological circumstance of multiple pregnancy, are factors that may render the cervix incapable of performing this function as efficiently as usual.

The data available from controlled trials of cervical cerclage in twin pregnancy are too few to be clinically useful. They are compatible with both a large beneficial effect and with a large adverse effect of the operation. Cervical cerclage does affect other aspects of clinical care and carries some specific risks. It should not be adopted specifically for twin pregnancy outside the context of further controlled trials of sufficient size and quality.

3.2 Prophylactic betamimetic agents

Trials have been conducted with a number of oral betamimetic agents, including isoxuprine, ritodrine, salbutamol, and terbutaline, in various doses, for the prevention of preterm labor in women with multiple pregnancy. In spite of the diversity of agents and the varying doses used, the results are consistent. No beneficial effect of prophylactic betamimetic administration has been detected on preterm birth, low birthweight, or perinatal mortality. Although prophylactic betamimetic agents have not succeeded in postponing delivery or in improving fetal growth, the four trials that provide information on the incidence of respiratory distress syndrome suggest that the frequency of this adverse outcome may be significantly reduced. No such effect has been found with prophylactic betamimetics in singleton pregnancies, and it might be a chance finding.

In the light of the theoretical dangers of chronic fetal exposure to betamimetic agents, prophylactic administration of these drugs should only be considered in the context of well-controlled clinical trials.

3.3 Hom
e uterine-activity monitoring

Trials of home uterine-activity monitoring in multiple pregnancy have been small, and not enough detail is available to evaluate the potential sources of bias. There are suggestions that babies born to mothers using home uterine-activity monitoring for twin pregnancy may be less likely to weigh less than 1500 g, or to be admitted to a special care nursery. Because of the high potential for bias, these data must be viewed with caution. Home uterine-activity monitoring, if adopted at all, should not be adopted outside the context of adequately controlled trials.

3.4 Hospitalization in multiple pregnancy

Prolonged bed rest in multiple pregnancy, with the aim of increasing the duration of gestation, improving fetal growth, and decreasing perinatal mortality, has been advocated for many years. The general considerations about the use of bed rest (see Chapter 14), apply equally strongly to its use in multiple pregnancy, as the practice is not innocuous.

Hospitalization and bed-rest in multiple pregnancy was introduced into clinical practice without adequate evaluation and the policy has still not been fully evaluated. Only recently have a few trials been conducted and further controlled evaluations are necessary to clarify the effects of this intervention. More information is available from twin than from higher multiple pregnancies.

There is some suggestion from these trials that routine hospitalization of women with twin pregnancies may result in a decreased risk of maternal hypertension, but a positive impact on more relevant outcomes has been negligible. Indeed the data suggest that routine hospitalization may have adverse effects. The risk of very preterm birth (less than 34 weeks gestation) and very low-birthweight babies was increased by routine hospitalization in these trials. No differences have been detected in the incidence of depressed Apgar score, admission to special care nurseries, or perinatal mortality.

Some obstetricians have suggested that hospitalization for bed rest in twin pregnancies should be applied only for women deemed to be at higher than average risk of preterm birth. Although this more conservative advice is possibly justified, there is remarkably little good evidence to support it. Only one such selective policy has been evaluated in a randomized trial. Comparison between the hospitalized and control groups of women with early cervical dilatation failed to show any benefits on the risk of preterm birth, perinatal mortality, fetal growth, or other neonatal outcomes. There is no basis for widespread adoption of the policy.

Only one trial of bed-rest in triplet pregnancies has been published. The results of this trial suggest that a number of adverse outcomes, including preterm birth, perinatal death, and low birthweight, can be reduced by routine hospitalization of women with a triplet pregnancy. The trial was small; the findings were compatible with chance; and further research is required.

4 Delivery

Virtually no data from controlled trials are available to help determine the choice between vaginal birth and cesarean section for women with multiple pregnancy. A single trial has assessed the effect of cesarean section for delivery when the second twin was in a non-vertex presentation. As would be expected, maternal febrile morbidity and need for general anesthesia was increased with cesarean section. No offsetting advantages in terms of decreased fetal or neonatal morbidity or mortality were found.

5 Conclusions

Additional support may be needed to help women with the emotional, practical, and financial demands of pregnancy and planning for more than one baby.

Routine early ultrasonography results in early diagnosis, detection of fetal abnormalities, and can determine amnionicity and chorionicity. Whether this improves the outcome for the mother or infant is unknown. Regular antenatal attendance permits screening for hypertension. Iron or folate supplementation may help to prevent anemia.

Prediction of preterm birth is difficult and the role of cervical assessment and clinical use of fibronectin remains to be evaluated by controlled trials. Therapies that aim to reduce the risk of preterm birth have not been shown to be effective.

There is currently no sound evidence to support the practice of routine bed-rest in hospital for women with a twin pregnancy; indeed the evidence suggests that this may be harmful. Whether or not such a policy would be justified in women at higher risk of preterm labor, such as those with triplet pregnancy or with early cervical dilatation, remains to be established.

The use of cervical cerclage, oral betamimetics, or home uterine-monitoring, for women with multiple pregnancy cannot be justified outside the context of adequately controlled trials. The indications for cesarean delivery with multiple pregnancy have not been established.

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Problem Kids - Parent Training

Much like the age old question of which comes first, the chicken or the egg? Many of the parents I see in my work as a family relationship author and trainer are not confident of their parenting skills and the children can sense their insecurity.

Those insecurities may stem from lack of role models in their youth, or that they want to over compensate for what they perceive are lacks in the family structure. They may feel that since there is divorce, financial problems, ADHD or other problems, it is easier to let the children get away with being angry, spoiled and demanding.

Parents are Teachers not Friends

Perhaps it may be easier short term to allow the kids to be in control or disrespectful, but it will cause multiple life problems for everyone if it is not curtailed. Angry Children make life miserable for everyone.

Parents are sometimes hesitant to talk about child behavior issues for fear of being judged by others. Many are not aware that most schools and many churches offer free or low cost parent training.

Children Need Consistent Boundaries

We all learn and behave better when we know what is expected of us and what is not going to be tolerated. When parents meet together in groups and discuss behavior issues, they will find clues, tips and ideas from other families and the leader of the class.

Parent training is not so much about what you are doing wrong, but on reclaiming your power and understanding how to work with your children to achieve a more cooperative home.

Empowered Parents - Well Behaved Kids

As you discover more ways to work together with respect, you may actually see your child reacting with anger and resistance. Stick to your guns. You are the parent and as the child sees that you are willing to change and grow in new ways, he or she will pick up on your behavior.

Change will not occur overnight and it may be a two steps forward, three steps back journey to a peaceful home. Give yourself some "atta - boys" for recognizing that what your family has done in the past needs to adjust and shift in order for problem kids to turn into peaceful partners towards a more respectful relationship. You will also want to use some encouraging phrases on the family to keep moving forward.

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