Anaemia is prevalent in 60% of the women during pregnancy and accounts for 40% of indirect causes of maternal deaths in the country. All women should undergo preconceptional evaluation with haemoglobin, says Dr T Ramani Devi, former president of Tamil Nadu Federation of Obstetrics and Gynaecologists, in an interview with Sinduja Jane. Edited excerpts:
What changes happen in the first, second and third trimesters in the mother and foetus?
Changes occur in all systems of the mother like cardiovascular, respiratory, hematological, renal, endocrine and genital organs to accommodate the growing foetus and to nurture the baby. If there are mal adaptations to the physiological changes, it can cause adverse maternal and foetal changes. Optimum weight gain of 8-10 kg throughout the pregnancy is ideal. The foetus grows slowly during the first and second trimester. Foetal growth is maximum in the last trimester with an increase in the weight of 500-1,000g. If the uterine environment is not congenial to the growth of the baby it can cause growth retarded babies or sudden intrauterine death. Hence, preconceptional optimisation of the mother is essential to achieve a safe maternal and fetal outcome.
For some women even after the expected date of delivery (EDD) labour does not start. How long they can wait?
All women do not have the EDD as per calculation and depends upon the menstrual cycle. If they have prolonged cycles — for example once in 40-50 days, their EDD may be delayed by 10-20 days and they should be given a corrected EDD based on the early scan at 12-13 weeks and that has to be followed. In general, if the date to deliver is getting delayed beyond the EDD, doctors will monitor the foetus for the blood flow and amniotic fluid. Doctors induce labour based on the clinical findings, otherwise we can wait for a maximum of 41 weeks. In high risk women, we induce labour by 39 completed weeks.
Who needs cerclage or cervical stitch and when should they consult the doctor?
Cervical stitch is needed in a woman , in whom, cervix or the mouth of the uterus opens prematurely before the due date, starting from 16 weeks onwards. It is safe to do the stitch, if there are previous mid trimester abortions leading to foetal loss. Cervical length can be identified during the first and second trimester scan. Now we have a pessary called Arabin pessary, which can be inserted into vagina around the cervix, which prevents the cervix from opening.
Should women who conceived through ART be extra cautious?
The general opinion is that women who conceived through ART need to be extra careful because most of them are older with comorbid conditions like high blood pressure, diabetes or obesity. Multiple pregnancies are also high among ART conceptions which need closer watch. Anaemia, thyroid dysfunctions and UTI are more common in such women and hence they need a proper follow up.
Anaemia is common in pregnancy in India. How to deal with it?
Anaemia is prevalent in 60% of women in the country during pregnancy. It can be higher in women from rural areas. All women need preconceptional evaluation with haemoglobin. It should be corrected with iron, folic acid and vitamin D supplements prior to pregnancy. Anaemia can cause maternal and foetal problems. It accounts for 40% of indirect causes of maternal deaths.
What is the importance of feeling foetal movements for the mother?
Foetal movements are the most important factor to assess foetal well-being. There should be a minimum of 10 foetal movements per day, any less the mother should visit the doctor. The baby will be alive for 24 hours only if foetal movements are absent.