Understand what to expect in your 1st Trimester, the symptoms as well as the tests your doctor will have you do and why.
This is the first 12 weeks of pregnancy counted from the first day of the last menstrual flow – although for about 2 weeks there is no pregnancy yet. It is impossible to know the exact day that conception takes place (even in one sexual encounter). This is because the sperms can be hanging around waiting for the egg for up to 3 days. The egg might also be playing hide and seek and keep the sperm waiting another 24 hours. Therefore, the sure way of dating the start of a pregnancy is the first day of the last period.
The phenomenal occurrence of sperm meeting egg (fertilization) happens in the Fallopian tube. Joined together as one (sperm and egg) it takes it roughly two weeks to travel through the Fallopian tube and land on the beautifully prepared sponge (endometrium) inside of the uterus. Here it implants (literally burrows into the sponge) and begins its intrauterine life. This baby to get nourishment from the mother and divides itself very rapidly making new cells. The cells separate themselves into two sets:
1. The ones that will become the baby, and
2. The ones that will become the support system in the form of a placenta, membranes, and cord.
Once the baby burrows into the sponge in the mother’s womb, the hormones the baby produces (pregnancy hormones) will be able to pass into the mother’s bloodstream. These hormones cause the various changes a woman experiences in early pregnancy. Different women experience different pregnancy signs and symptoms and even in the same woman; there may be differences in different pregnancies. These are the same hormones that are tested either in the mother's blood or urine to determine the presence of pregnancy i.e. pregnancy test positive or negative.
The following are some of the common symptoms that many women will experience:
1. Lower abdominal pressure and cramping just about when the menstrual period is expected as the baby is burrowing into the mother’s sponge. This causes a sensation of lower abdominal pressure and cramping as if the period is about to start. Many women will wear protective sanitation at the time only no bleeding will occur. In the few cases when bleeding occurs, it is lighter, lasts fewer days and is usually of no consequence. Some of the ladies who experience this bleeding will think it’s a menstrual flow and when calculating the age of the pregnancy, they may think they are 4 weeks less than they actually are. An early gestation Ultrasonography scan will usually give the correct dates.
2. Excessive salivation and a metallic taste in the saliva.
3. Excessive gas both belching and passing flatus.
4. Bloating of the abdomen due to bloated intestines. Some women even think their pregnancy is already showing while it’s all gas bloating. Pregnancies show in the second trimester.
5. Nausea with or without vomiting. Fortunately, this eases off after the first trimester. Some women lose weight in the first trimester due to a lack of proper feeding due to poor appetite. Others vomit so excessively that they have to be administered intravenous fluids in the hospital.
6. Tenderness of breasts especially the nipples. This is accompanied by the darkening of the areola (the area of the breast surrounding the nipple) and the appearance of some small bumps around the same area.
7. Strong smells. A pregnant woman’s sense of smell is much of the time very heightened and she becomes extremely sensitive to smells. Much of the time, her husband’s cologne is the culprit and he is forbidden to wear it!
8. Fatigue, laziness, and forgetfulness. There is a hormone that slows the mother down so as to be better accommodating to her guest in the uterus. Pregnant women should always have a diary to write what is their to-do list and any questions they have to ask. There is danger in forgetting even where the diary was lastly kept.
9. Heartburn and acidity. This usually starts in the first trimester and gets worse as the pregnancy progresses. In the 3rd trimester, it can be severe enough especially when the pregnant woman lies down and the intake of antacids may be necessary.
10. Frequent passing of urine. The pregnancy hormones cause an increase in blood flow to the kidneys and improve kidney efficiency. This is because the mother’s kidneys will have to clear her own impurities and those of her growing baby. The amount of urine and the frequency of passing it increases. Also as the pregnancy grows, the uterus which is increasing in size pushes into the wall of the bladder as they share the same pelvic compartment. This results in the bladder not filling up to its full capacity and hence frequent passage of urine. The uterus grows out of the pelvic cavity after the first trimester so this competition for space eases somewhat.
11. Constipation. This is very frequently experienced. Intake of a lot of water accompanied by food that is high in fiber will ease constipation.
12. Mood swings. Accompanied by the realization that one is completely responsible for another human being that is developing. This can be quite scary.
Laboratory Tests
Your obstetrician will ask you to do several lab tests – usually termed the antenatal profile. Countries differ in the tests they emphasize should be done. In Kenya we usually request for a check-up for:
1. Blood group
2. Rhesus type
3. Full haemogram
4. Thyroid function
5. Blood sugar levels
6. Syphilis
7. Hepatitis B
8. Rubella
9. HIV
10. Urine
11. Ultrasound pelvis
Blood Group and Rhesus
Every pregnant woman must have her blood group checked – the A, B, AB, and O. The rhesus factor of each pregnant woman is also of great importance, not only for the current pregnancy but for all the future pregnancies. Confirm that your doctor has checked you for this. Once you know your blood group and Rhesus factor they remain that way for the rest of your life so you do not need to check again in subsequent pregnancies. All the other tests of the antenatal profiles are checked for each pregnancy.
Full Haemogram
This is important for the following reasons:
· Checks the oxygen-carrying capacity of your blood.
· Checks that your white blood cells (fighter cells) are normal.
· Confirms that your platelets are normal. These are increased in pregnancy in preparation for the prevention of excessive bleeding after delivery – the role that platelets play. The increase of platelets in a way also thickens the flowing blood thereby making it much easier for a pregnant woman’s blood to clot inside her veins (deep vein thrombosis – DVT) especially if the pregnant woman is not physically very active. It is important to especially walkabout in pregnancy. Depending on the result, your doctor may advise you to take blood building medicines or inform you about foods that are rich in iron.
Blood Sugar
The condition of diabetes and the state of pregnancy have very unique interactions. Your doctor needs to know your diabetes status for proper management of your pregnancy.
Syphilis
This disease, if in the mother’s bloodstream can cause severe congenital malformations to the baby she is carrying. If detected early in pregnancy by various tests, it can be treated before it deforms the baby.
Thyroid Function
The abnormal functioning of the thyroid gland in the mother – where it is over-active or under-active is detrimental to the carrying of the pregnancy. Your doctor needs to know whether your thyroid is normal or if any intervention is required.
Hepatitis B
This can be transmitted from mother to child and the baby must be immunized against Hepatitis B immediately after delivery.
HIV status
This must be known so as to take measures to try to prevent mother-to-child transmission of infection during pregnancy, during labor, delivery, and after delivery.
Urine
This will be checked in early pregnancy and usually severally during pregnancy. Urine tests are useful for testing a number of abnormal conditions during the entire pregnancy.
Pelvic Ultra Sound
This is usually done as early as at 6 weeks gestation to confirm the location and viability of the pregnancy. An ultrasound scan at 11-14 weeks is done to check for any gross fetal abnormalities as at this age the baby has formed all its organs.
AUTHOR: Dr. Jane Wakahe
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