In developing countries like India, the three most common reasons for delays in women healthcare are –
1. Deciding to seek healthcare
2. Reaching a healthcare centre
3. Receiving appropriate timely care at the centre

The Condom (Barrier Method)
Condoms help in protecting against STI too. Available for males and females, it’s hormone free and can be used on demand. However, it may tear and come off if not used correctly.

The Oral Contraceptive Pill (OCP)
The OCP is a hormonal method to control pregnancies. There are many types available these days. The only-Progestin and the Oestrogen + progestin combination pill allows for sexual spontaneity and is highly effective. It does not interrupt coitus and even controls both hormone levels for irregular menses or hormonal skin outbreaks in women. It is important to remember to take it regularly. Forgetting to take it is not safe. This is not meant for men, and neither does it protect against STIs. It is best to consult a doctor for advice.

Intrauterine device (IUD)
An IUD is a small T-shaped device made from plastic or copper containing progesterone which is fitted by a medical practitioner into the woman’s uterine cavity. The hormones released by the device slowly, over time, prevent pregnancies. The copper and hormone laden devices are 99.8% effective. It requires a qualified person to insert it and does not offer protection from STIs. There may be spotting or bleeding for the first few months. Requires medical professional intervention.

Contraceptive Implant
Contraceptive implant is a small rod containing the hormone progesterone, placed subcutaneously. This hormone prevents the release of the egg. It’s very efficacious, long-lasting and has no impact on sexual activity. The contraceptive implant doesn’t offer any protection from STIs either. Requires medical professional intervention.

Contraceptive injection
The contraceptive injection is given intramuscularly, which slowly releases progesterone into the blood. The injection has many advantages and also gives the opportunity to track cycles. It does not protect against STIs. Requires medical professional intervention.

Emergency Pill or Morning After-pill
The Morning pill is hormonal in composition and is used after unprotected sex. This is a common contraceptive used by sexually assaulted women to avoid unwanted pregnancies. Also called the Morning after-pill, it is an over-the-counter pill that any woman can take. It has 85% effectiveness within 3 days of unprotected sex. Maybe self prescribed but as a one off. Repeated use with no medical advise may be harmful.

Contraceptive Ring
The contraceptive ring is a plastic hormone-releasing ring placed in the vagina by women, lasting 3 weeks. One week off and a new ring can be inserted. This cannot be used by women who are advised to not use oestrogen.

Diaphragm
The diaphragm is a small silicone dome placed in such a way that it sits on top of the opening to the uterus, the cervix. It can be kept inserted during and after sex for a few hours. It’s reusable but takes practice to use. Requires guidance for application initially.

Sterilisation
Sterilisation is a minimally invasive, permanent method of contraception for men and women under anaesthesia.

The best method for you should be determined after having an open and complete discussion with your doctor.

During these new times with the pandemic, Seeking help for family planning and contraception is, unfortunately, low on the list of medical issues to venture into a clinic/hospital setting. There is also the concern that we may have reduced stocks of contraceptives from UNFPA or some methods of contraception. For example, Depot hormone implants, Copper Intrauterine Devices (IUD), Oral contraceptive pills (OCP), and condoms. The issue of unavailable healthcare providers or closed clinics is also ever-present. Unintended pregnancies, additional numbers of complications in obstetric care and more women resorting to unsafe abortions will be a setback to people, families and the development of the society, especially in these uncertain times.

The advantages of birth spacing are well known. Avoiding pregnancy is advisable for women who have had childbirth during the pandemic. For their personal health and lifestyle and given the reduced resources or opportunities to receive health care, the need for contraception when not keen to expand family is a must.

The methods easily available are using the Lactational Amenorrhoea Method (LAM). To enhance its efficacy, barrier methods such as the condoms, the oral progestin‐only pill (a minimum of 6 months), and DMPA (look at how to enable self‐administration with subcutaneous route and training) should be advised.

One of the best methods, long‐acting reversible contraceptives (LARCs), can also be advised. Some of these are the progesterone implant and the intrauterine system (IUS). The copper IUD (PPIUD) inserted just following delivery is easily available, safe, convenient and is highly cost‐effective. Infection rates are very low too and when done immediately post-delivery, it is relatively painless.

As the WHO Director General has said, “No one will be safe unless everyone is safe.”
This includes women who are looking to not conceive. At Zoi Hospitals and Clinics, we believe in empowering women to take their health into their own hands. They take expert advise and take a stand. Social distancing, limitation on mobility and attention to COVID-19 requires new ways to take care of contraception and reproductive well-being.

Advice and counselling on contraception can be sought online through virtual audio-video consultation. All one has to do is set up an appointment via a mobile connection and talk to the women’s health experts today. The likelihood of a hospital or larger set up to stock contraceptive methods is higher too. If required, go to the hospital or clinic for insertion of any IUD or depot as it reduces the frequency of hospital visits. And Of course, postpartum contraception is an important access.

We at our centre, believe it is our top priority to provide any service with utmost precautions and care. Strong, aware healthy women is our purpose. With a team of 4 gynaecologists who have been working tirelessly and conscientiously through the pandemic, we want women to stop waiting for things to ‘go back to normal’ and to go forward in ‘the new normal’.
For More information and for guidance for initiating contraception, you can get in touch with our doctors via direct in hospital or nline consultations via our website.

References

FIGO Wileys Obstetrics and Gynaecology editorial Jun 2020

Risk Factors That Develop Hypertension During Pregnancy Include:

• • Being overweight or obese.
  • Not getting enough physical activity.
  • Smoking.
  • Drinking alcohol.
  • First-time pregnancy.
  • A family history of pregnancy-related hypertension.
  • Carrying more than one child.
  • Age (over 35).
  • Assisted reproductive technology (such as in vitro fertilization, or IVF).
  • Having diabetes or certain autoimmune disease.

Symptoms Of Hypertension:

• • High blood pressure.
  • Too much protein in your urine (called proteinuria).
  • Swelling in your face and hands. Your feet may also swell. As many women have swollen feet during pregnancy, it may not be a sign of a problem. Best to talk to your obstetrician.
  • Headache that does not go away.
  • Vision problems, including blurred vision or seeing spots.
  • Pain in your upper right abdomen.
  • Trouble breathing.

Complications Of Hypertension During Pregnancy:

• • Placental abruption, where the placenta separates from the uterus.
  • Poor fetal growth, caused by a lack of nutrients and oxygen.
  • Preterm birth.
  • A low birth weight baby.
  • Stillbirth.
  • Damage to your kidneys, liver, brain, and other organ and blood systems.
  • A higher risk of heart disease.
  • Eclampsia, which happens when preeclampsia is severe enough to affect brain function, causing seizures or coma
  • HELLP syndrome, which happens when a woman with preeclampsia or eclampsia has damage to the liver and blood cells. It is rare, but is a serious complication.

Treatment Of Hypertension During Pregnancy:
Delivering the baby can often cure preeclampsia and gestational hypertension. When making a decision about treatment, there are several factors that your provider should consider. They include how severe it is, the weeks of pregnancy, and the potential risks to you and your baby.
The factors are listed:

• • • If you are more than 37 weeks pregnant, your provider will likely want to deliver the baby.
    • If you are less than 37 weeks pregnant, your health care provider will closely monitor you and your baby which include blood and urine test. Monitoring for the baby often involves ultrasound, heart rate monitoring, and checking on the baby’s growth. You may need to take medicines, to control your blood pressure and to prevent seizures. Some women also get steroid injections, to help the baby’s lungs mature faster. If the preeclampsia is severe, your provider may want you to deliver the baby early. Note that you may need admission during pregnancy for evaluation and to monitor your B.P.

The symptoms usually go away within 6 weeks of delivery. In rare cases, symptoms may not go away, or they may not start until after delivery (postpartum preeclampsia).

Diet During Pregnancy:

• Diet is a very important factor during pregnancy.
• Take frequent and small meals and finish your dinner early.
• Include daily servings of proteins like nuts, eggs, fish, lean meat and pulses.
• Include dairy products like milk and curds.
• Include all seasonal vegetables and fruits.
• Include 3-4 litres of fluids daily for a good hydration maintenance.
• Food hygiene is also very important so wash all the raw fruits and vegetables thoroughly.
• Completely avoid undercooked or outside food, undercooked raw meat, unpasteurised milk and undercooked eggs.
• Wash hands immediately after you handle your pets and gardening.
• Eating for two people during pregnancy is not needed.
• The extra supplementation of folic acid during the first 3 months prevents neural tube defects in babies. Iron, calcium and vitamin D supplementation is crucial throughout the pregnancy.

Exercise During Pregnancy:
Exercise is very important during pregnancy. Brisk walk and yoga can be done. Exercise under a trained antenatal trainer is advisable.

Exercises help you cope up with postural changes during pregnancy and prevent back ache and also prevent excessive weight gain during pregnancy. Your pregnancy weight gain depends on your pre-pregnancy weight. Pelvic floor exercises like Kegel exercises help strengthen pelvic floor muscles because weakening of them lead to stress incontinence like urine leak while coughing or sneezing. Exercises during pregnancy increase the chances of normal delivery.

Avoid Smoking, Drinking Alcohol, Excessive Intake Of Caffeine:
In the first trimester, drinking alcohol can increase your risk of miscarriage. And while in the third trimester, it can affect your baby’s brain development. It’s recommended that you avoid alcohol completely in the first trimester. If you decide to drink after this stage, stick to no more than one or two units of alcohol, not more than once or twice a week. Mums-to-be who drink heavily on a regular basis are more likely to give birth to a baby with Fetal alcohol spectrum disorders (FASD). These are problems ranging from learning difficulties to more serious birth defects.
Too much caffeine may contribute to your risk of having a  low-birth-weight  baby. Smoking during pregnancy  can cause serious health problems for you and your baby.

Smoking increases your baby’s risk of:
Premature birth
Low birth weight
Stillbirth
Sudden infant death syndrome (SIDS) or “cot death”

Smoking also makes the following pregnancy complications more likely to Miscarriage ,  Ectopic pregnancy, Placental abruption , where the placenta comes away from the womb wall before your baby is born.

Sleep:
Pregnant women need an 8 hour sound sleep. It’s highly advisable to sleep on one side, as sleeping straight causes pressure to the main blood vessels in front of the backbone causing a decrease in blood supply to your womb. Sleeping on ones left side is best.
Pregnant women should lay down at least for 30 minutes during the day time as it decreases fatiguability and relaxes the muscles.

Read on to understand when you should consult your doctor amidst the COVID-19 conditions.

Most common symptoms in the first few weeks of pregnancy

Vomiting
Morning sickness is the most common symptom in the first few weeks of pregnancy and it is normal. But if you are throwing up so much that you can’t keep liquids down or you feel that there is a decrease in your urine output, then you need to consult your doctor right away as it can lead to severe dehydration which is neither good for you nor your baby.

Constipation
It is a common symptom due to slowing of bowel movement caused by hormonal changes or due to iron in prenatal vitamin supplements. There is no need to worry immediately as most women improve with a high fibre diet, increasing fluid intake and exercising.

Vaginal bleeding
Approximately 25% of women experience some spotting /bleeding in the first few weeks of pregnancy. If you experience bleeding with abdominal cramps, kindly contact your doctor immediately. The doctor will examine to see for any signs of miscarriage / local vaginal infection or local lesions causing the bleeding.

Painful urination
Frequent urination is a common complaint in pregnancy, but if there is pain or burning upon emptying your bladder it indicates a bladder infection or a urinary tract infection. Urinary tract infection, if left untreated for long, can lead to complications such as preterm labour and infection spreading to kidneys. It’s not an emergency but make sure you schedule your visit soon.

Painful and swollen legs
The growing uterus can impede blood circulation, causing blood to pool in your feet and legs which generally decreases in a few hours with limb elevation, adequate hydration and staying active. If one-sided pain is associated with swelling, kindly contact your doctor as pregnant women are at greater risk for forming blood clots in the deep veins of the legs due to hormonal changes and pressure from the uterus on the veins and in the pelvis.

Some of the biggest concerns in the last few weeks of pregnancy

Decreased fetal movements
We recommend checking the growth of your baby by looking for ten movements in 12 hours or three movements each within one hour after every meal. If you don’t feel any movements, drink a glass of fruit juice and lie down to your left side in a quiet room for one hour and if you still don’t feel any movements, kindly contact your doctor immediately.

Watery discharge
If you experience a sudden gush of fluid from your vagina, contact your doctor immediately and head to the hospital. The doctor will assess and tell you if your water has broken or if it is just some urine due to compression of the bladder by the fetal head or vaginal infection.

Severe headache
It can indicate high blood pressure which can reduce blood flow to the baby and cause health problems for the mother. It is advised to check your blood pressure at home twice a week and to report to your doctor if the readings are higher than 140/90mmhg. Contact your doctor immediately if you experience any of these associated symptoms like vomiting, upper abdominal pain, blurred vision, excessive swelling of feet and face or a rapid weight gain.

If you notice any of the above-mentioned symptoms, don’t hesitate to contact your doctor. At Zoi Hospitals, we are restricting the number of attendants/visitors and deferring the non-essential OPD visits. Pregnant women are seen on a different floor/wing and not mixed with other patients. We are taking adequate precautions with PPE and maintaining social distance at the hospital. Scans and tests are done with sanitisation measures taken between each patient and by use of PPE by the staff and doctor. We have also started online audio/video consultations and you can do your part by being aware and being in communication with your doctor.

In these difficult times, it is best to take utmost care and precautions and stay at home as much as possible. However, in case of an emergency, please don’t panic, stay calm and call for help immediately. Wishing you a safe pregnancy.

WEEKS 1 TO 3:
At this stage, the fertilisation of the egg is still recent within the mother’s womb and the zygote is just about getting down to attaching itself to the uterus. By this stage, your baby has been formed and is busy growing from the initial 2 cells.

WEEK 4:
By now, the medical term for your baby is blastocyst – where multiple cells bunch up to form a fuzzy little ball. A lot like a bunch of tiny little peppercorns coming together to form a hazy ball.

HOW YOU WILL FEEL:
This is the start of the first signs that you are pregnant – slight spotting or missed periods. However, most women dismiss these symptoms as they can easily be confused with regular occurrence since they are not entirely out of the ordinary.

WEEK 6:
Your baby is bigger than last week, but not by much. For now, your baby is the size of a sweet little pea! And what’s more, your little cutiepea’s now growing its very eyes, nose, tongue, and vocal chords!

HOW YOU WILL FEEL:
Your baby bump may still not be visible, but you may experience pregnancy-related issues like mood swings, cramps and sore breasts.

WEEK 8:
Did you know a 7-week old baby has a little tail? Yes, you read that right! But, worry not, by the eighth week, the tail is long gone! By now, your baby is about half an inch in length and very closely resembles a rajma bean! Like so –

HOW YOU WILL FEEL:
Moms-to-be find themselves becoming more and more familiar with the early stages of pregnancy during this stage. A rush of hormones will leave you more sensitive to the faintest of smells and will also cause you to dream about stranger things than usual! Other issues could possibly include nausea, lightheadedness, and bloating.

WEEK 10:
At this stage, your baby very closely resembles a cherry and has a fully functioning heart. He or she will also begin to grow a set of arms and legs by now!

HOW YOU WILL FEEL:
Apart from the prevailing symptoms and feelings, you may also begin to experience pain in the abdomen as your uterus begins to expand to make room for your little ‘tenant’!

WEEK 14:
Your baby is still a lemon – but a bigger one at that! Moreover, he or she is now beginning to express himself or herself with their facial muscles and change expressions ever so often!

HOW YOU WILL FEEL:
This is the best phase of your pregnancy. Levels of nausea will go down as you begin to see a spike in your energy levels as well as your libido! You will have surprisingly thick, silky hair and won’t feel lethargic anymore.

WEEK 18:
Your baby is now growing at a rapid pace. He or she now has a more developed sense of hearing now and is also now capable of hearing the soothing rhythm of your heartbeat. And guess what? Your baby is now the size of a sweet potato!

HOW YOU WILL FEEL:
Since the baby is now growing at a rapid pace, you will begin to feel more different than ever as you experience dreams strangers than ever before, some weight gain as well as an increase in the fluids within your body.

WEEK 20:
Your baby is almost as big as a banana now. Second-time mothers can usually feel the baby move at this stage as the baby becomes more active every day.

HOW YOU WILL FEEL:
As your uterus expands to make more and more room for your little one, it puts pressure on your body and puts pressure on your ligaments. You may feel dizzy and lightheaded; Swelling and shortness of breath may also occur. On the other hand, you may even experience high bursts of energy!

WEEK 24:
Your baby is quite the big girl/big boy now! Almost big enough as an ear of corn, their lungs are now developed enough to survive a premature delivery!

HOW YOU WILL FEEL:
The linea nigra or the line that runs along the centre of your belly below the belly button, will darken and be very visible at this stage. You may also see stretch marks as your baby pushes your uterus out, and your skin expands to accommodate this change.

WEEK 28:
Your baby’s hearing is so well-developed by this stage that it can distinguish the sound of your voice! Oh, and he or she also resembles a small-sized bottle gourd and weighs around a kilogram at this stage!

HOW YOU WILL FEEL:
As your baby grows and your stomach expands, you will experience several difficulties. The growing size of your uterus will create pressure on your bladder, thus creating frequent urges to empty it. Your baby’s movements will also be stronger, and will probably keep you up at night.

WEEK 32:
Not only will your baby be able to taste by now but he or she will also be able to sneak in a hiccup every now and then! Your baby’s brain is also developing at a rapid pace right now, which is a huge reason behind the not-so-little one now closely resembling a Chinese cabbage! Your baby, at this stage, would weigh around 1.5kg to 2kgs.

HOW YOU WILL FEEL:
By now, your baby is now almost at your rib cage – causing shortness of breath, an achy back, heartburn as well as the swelling of your extremities. Vaginal discharge is also likely to increase, followed by the darkening of your nipples and leaky breasts. It wouldn’t be out of place for you to even experience light contractions by this point!

WEEK 36:
Well, from a Chinese cabbage, your baby has progressed to a happy little muskmelon by now – tilting his or her head down to the pelvis.

HOW YOU WILL FEEL:
Since your baby is now tilted downwards, you will feel more pressure on your pelvis. However, this will automatically free up more of your lung space – making breathing easier than before. Oh, you might also be needing bathroom breaks more frequently than before because your baby is now pressing down on your bladder.

WEEK 40:
Congratulations! You have made it to the end – and so has your little one who now, by the way, is as big as a watermelon!

HOW YOU WILL FEEL:
By now, you would already have experienced the Braxton Hicks contractions. Apart from this, you may also experience a mucous-like blood stained discharge. You may also experience anxiety as you anticipate the baby’s delivery.
After a certain stage, every baby takes his or her own pace of growth. Now, more than ever, hereditary factors, maternal nutrition and overall health come into play at this stage. This is why every baby has a different size, weight and head circumference at the time of birth.
Resting well and eating right are the best things you can do for yourself right now. So do that, and everything else you can to keep yourself feeling fine and healthy because soon, it would be time for you to bring your tiny little tenant out into the real world!

So, what is menstrual hygiene?

Simply put, it refers to the management of hygiene associated with the menstrual process. This involves using a proper menstrual management material like sanitary pads, tampons, cups etc., changing them at regular intervals, disposing them off responsibly and practising personal hygiene.

Did you know that in India, only 1 in every 2 girls has knowledge about menstruation before their first period? And even lesser women know how to maintain menstrual hygiene. Turns out, keeping a good menstrual hygiene practice leads to better reproductive health. It also keeps vaginal infections and other reproductive diseases at bay.

Here are some tips to maintain your menstrual hygiene and have a happy period:

Change your sanitary pad every 4-5 hours

Majority of the urban women in India use sanitary pads and it is advisable to change them every 4-5 hours, especially on the first two days when the flow is heavy. On other days too, wearing a pad for more than eight hours is not advisable.

Choose your menstrual sanitary pad/ cup/ tampon carefully

Sanitary pads which are popular are usually made of a highly absorbent but synthetic material which may lead to rashes in the peri-vaginal area. Cotton or organic material pads are much better. Many brands are now available online, so try one that suits you and stick with it. Menstrual cups are becoming popular too. Picking the right size is important for comfort and ease of use. Tampons which come with a disposable insertion mechanism are much better than the ones that have to be inserted with one’s hands. Never leave a tampon overnight. it should be changed every 4-5 hours. Keeping it beyond that could lead to serious infections.

Clean reusable material properly

For women who use reusable pads or cups, it is very important to clean them thoroughly to reduce risk of infections. Ensure you don’t exceed the number of reuses that a particular material allows.

Don’t use more than one pad at a time

Some women think that in the days of heavy flow, two pads are better than one to prevent staining the clothes. This, however, is not true. Use one pad at a time to prevent vaginal infections and change it more often if you are experiencing heavy flow.

Keep the vaginal area clean

While it is a must-do at all times, keeping the area clean becomes especially important during periods. Vaginal douches though are not recommended unless medically prescribed as they eradicate normal health microbes in the vagina and may introduce pathogens in it. Use warm water with mild soap to clean the area. However, if you experience itching or rashes, please see your gynaecologist immediately.

Wear comfortable and clean undergarments

Avoid wearing tight undergarments or underwears made of non-breathable fabric. Wear cotton knickers that don’t stick to your skin to avoid rashes and infections during these times. Clean them everyday. Plastic lined period underwear should be avoided, as they reduce the sense of the flow, retention of moisture in the peri-vaginal area causing skin breakouts and cause friction with the sensitive skin around the perineum.

Dispose the sanitary pads/tampons responsibly

The disposal of the used pads and tampons should always be done by wrapping them in the provided cover or paper and thrown in a closed bin in the non recyclable bin if made of synthetic materials. Do not flush them as they clog the pipes. 

Visit your friendly gynaecologist

It is important to regularly visit your gynaecologist for the upkeep and maintenance of your menstrual health. Discuss any abnormality or discomfort with them and seek medical advice on some of the best practices on menstrual health. 

Involve the men in the menses talk

While this may not be directly related, it is important to create awareness about menstrual health in the minds of men that we are living with. Involving them in the conversations and breaking  the taboo and shame around menses will ensure their support in helping the women maintain their hygiene. Monetary support must be provided by men for women to purchase clean and hygienic products in households where men are the major breadwinners. 

So ladies, practice good menstrual hygiene, talk about it to your friends, share and spread the word, break the taboo. Take charge of your menstrual health and stay safe!

Novel coronavirus (SARS-COV-2) is a new strain of coronavirus causing COVID-19, first identified in Wuhan City, China. Other coronavirus infections include the common cold (HCoV 229E, NL63, OC43 and HKU1), Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).

Cases of COVID-19 globally have evidence of human to human transmission. Recently cases have appeared where there is no evidence of contact with infected people.This virus appears to spread readily, through respiratory, fomite or feco-oral methods. People are recommended to employ strict infection prevention and control (IPC) measures; guidance is available as per local Health advisories.

TRANSMISSION FROM MOTHER TO CHILD –

Two cases of possible vertical transmission (transmission from mother to baby antenatally- before delivery or intrapartum- during delivery) have been reported. In both cases, it remains unclear whether the transmission was prior to or soon after birth. Expert opinion is that the fetus is unlikely to be exposed during pregnancy. A case series published by Chen et al tested amniotic fluid, cord blood, the newborn’s throat swabs and breast milk samples from COVID-19 infected mothers and all samples tested negative for the virus. Furthermore, in a different paper by Chen et al, three placentas of infected mothers were swabbed and tested negative for the virus; and in another case series by the same team, of three infants born to symptomatic mothers tested for the coronavirus, none had positive tests.

Transmission is, therefore, most likely to be as a newborn and in another case series by the same team, of three infants born to symptomatic mothers tested for the coronavirus, none had positive tests. There is currently no evidence concerning transmission through genital fluids.

EFFECT ON THE MOTHER/SYMPTOMS-

The large majority of women will experience only mild or moderate cold/flu-like symptoms. Cough, fever and shortness of breath are other relevant symptoms. More severe symptoms such as pneumonia and marked hypoxia are widely described with COVID-19 in older people, the immunosuppressed and those with long- term conditions such as diabetes, cancer and chronic lung disease. These symptoms could occur in pregnant women so should be identified and treated promptly. At present there is one reported case of a woman with COVID-19 who was admitted to hospital at 34 weeks of pregnancy, had an emergency Caesarean section for a stillborn baby and was admitted to the intensive care unit with multiple organ dysfunction and acute respiratory distress syndrome, requiring extracorporeal membrane oxygenation. Within the general population, there is evolving evidence that there could be a set of asymptomatic individuals or those with very minor symptoms that are carrying the virus, although the incidence is unknown.

EFFECT ON THE FETUS-

There are currently no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to COVID-19. Case reports from early pregnancy studies with SARS and MERS do not demonstrate a convincing relationship between infection and increased risk of miscarriage or second-trimester loss.

As there is no evidence of intrauterine fetal infection with COVID-19 it is therefore currently considered unlikely that there will be congenital effects of the virus on fetal development.

There are case reports of preterm birth in women with COVID-19, but it is unclear whether the preterm birth was always iatrogenic (brought about by a medical professional or by treatment or by treatment environment), or whether some were spontaneous. Iatrogenic delivery was predominantly for maternal indications related to the viral infection, although there was evidence of fetal compromise and pre-labour premature rupture of membrane, in at least one report.

HEALTH ADVICE FOR PREGNANT WOMEN –

As a pregnant woman, the news of the coronavirus pandemic may have caused you concern.

We would like to reiterate that the evidence we have so far is that pregnant women are still no more likely to contract the infection than the general population. And it’s high in the general populace right now. What we do know is that pregnancy, in a small proportion of women, can alter how your body handles severe viral infections. This is something that midwives and obstetricians have known for many years and are used to dealing with.

What is there is the need to restrict the spread of illness because if the number of infections was to rise sharply the number of severely infected women could rise and this could put the lives of some pregnant women in danger.*

My friendly gynaec’s take on Pregnancy and SAR CoV 2 pandemic is:

• If you get infected with COVID-19 you are still most likely to have no symptoms or a mild illness from which you will make a full recovery
• If you develop more severe symptoms or your recovery is delayed this may be a sign that you are developing a more significant chest infection that requires enhanced care, and our advice remains that if you feel your symptoms are worsening or if you are not getting better you should contact your maternity care team straight away for further information and advice.
• If you are well at the moment and have no complications in any past pregnancies and no conditions like diabetes, hypertension, immunosuppression, kidney disease, the following practical advice may still be helpful
  • MOST IMPORTANTLY SOCIAL DISTANCING (more accurately Physical distancing). This is a non-pharmaceutical infection prevention and control intervention implemented to avoid/decrease contact between those who are infected with a disease/pathogen and those who are not, so as to stop or slow down the rate and extent of disease transmission in a community. HOW? Keeping a distance of at least one metre in various necessary interactions and activities
  • Disinfection of surfaces to reduce fomites related spread.
  • For women working outside the house, it is preferable to take Work from Home.
  • Avoid non-essential travel. If travel is undertaken, it is preferable to use a private vehicle. If public transport is used, the distance should be maintained.
  • Avoid gatherings and functions to celebrate the 7-month milestone, which is a common cultural practice.
  • Minimize visitors from coming to meet the mother and newborn after delivery.
  • Continue to take necessary precautions like hand washing
  • Do not self medicate, approach health care in case of any respiratory symptoms like a cold, cough.
  • Defer routine visits but only after consulting with your obstetrician. Essential milestone visits such as the 12 and 19-week scans are needed. If you have a routine scan or visit due in the coming days please contact your maternity unit for advice and to agree to a plan. You will still need to attend for a visit but the appointment may change due to social distancing and the medical team due to logistical aspects in these times.
  • If you are between appointments, please wait to hear from your maternity team.
  • Women are advised to note fetal movements every day. The next visit can be at 32 weeks of pregnancy.
  • You can consult the healthcare provider telephonically or through a web platform for minor ailments and questions.
• If you have an urgent problem related to your pregnancy but not related to Coronavirus, get in touch using the same emergency contact details you already have.
• If you have symptoms of Coronavirus, contact your maternity service and they will arrange the right place and time to come for your visits. You should not attend a routine clinic.
• You will be asked to keep the number of people with you to a minimum.This will include being asked to not bring children with you to maternity appointments.
• At this time it is particularly important that you help your doctor take care of you. If you have had an appointment cancelled or delayed, and are not sure of your next contact with your doctor, please get in touch with them.

Pregnant women are a special category in terms of healthcare and are possibly more susceptible. They should therefore, follow these guidelines fastidiously. They can protect themselves by the motto “Do the Five”. The principle elements of this are:

Instructions for contacts, When a pregnant woman is home quarantined

The home quarantined pregnant lady should:

· Stay in a well-ventilated single-room preferably with an attached/separate toilet.

· If another family member needs to stay in the same room, it’s advisable to maintain a distance of at least 1 meter between the two.

· Needs to stay away from elderly people, pregnant women, children and persons with co-morbidities within the household.

· Restrict his/her movement within the house.

· Under no circumstances attend any social/religious gathering e.g. wedding, condolences, etc.

General health measures to be followed in quarantine include hand washing, avoiding sharing fomites, wearing a surgical mask and changing it every 6 to 8 hours with correct disposal in 1% hypochlorite solution. If symptoms appear during quarantine, the pregnant woman should contact a health facility by telephone and follow the given advice.

Family members of the pregnant woman quarantined at home should keep a distance from her at all times and avoid direct contact with her and her fomites. Disposable gloves should be used in case soiled linen has to be handled. Visitors should not be allowed. Clothes should be washed separately.

The duration of home quarantine is 14 days from the time of exposure to a confirmed case or earlier if a test is performed on a suspect case and it is negative.

Source:

*SOURCE- ROYAL COLLEGE OF OBSTETRICS AND GYNAECOLOGY ,UK ,UPDATED MARCH 18 2020

FOGSI 28/3/2020 (FEDERATION OF OBSTETRICS AND GYNAECOLOGICAL SOCIETY OF INDIA)

If you answered yes to either question, you may be suffering from PCOS.

One of the most common female hormonal disorders is PCOS. It raises a lot of questions around exercise and diet but the good news is that with the right approach to nutrition and fitness, PCOS doesn’t have to be a barrier to getting fit and feeling awesome. Better still, the right food and fitness approach can help manage it.

What is PCOS?

Polycystic Ovary Syndrome is a complex condition that affects how your ovaries work. Although the exact cause is unknown, PCOS is related to abnormal hormone levels including resistance to insulin and raised levels of testosterone. It often runs in families and you’ll usually start to notice symptoms in your late teens or early twenties.

Symptoms can include irregular or absent periods caused by an imbalance of hormones, difficulty in getting pregnant, excess facial and body hair, weight gain, thinning hair on your head and oily skin and acne.

Not everyone with PCOS will have all of the symptoms and they can vary in severity from person to person so if you think you may have the syndrome, the first port of call should be your General Physician who can help you get a diagnosis.

While there’s no cure for PCOS, the great news is that symptoms can be managed with the right lifestyle changes including exercise and a healthy diet and medication if needed.

What causes PCOS?

We don’t have a definitive cause for PCOS. Research says it is purely a lifestyle disorder, but genetics and environmental factors may also play a role sometimes. Although PCOS is not completely restricted to obese women, there is an entity called lean PCOS seen in lean women with a poor lifestyle. Obesity doesn’t cause PCOS but makes it worse because of insulin resistance which leads to diabetes, with high levels of insulin—a hormone made by your pancreas.

Five lifestyle changes that help manage PCOS

Changing your lifestyle will not be easy, which is why we suggest that you start slow, but without delay.

Here are 5 lifestyle changes that can help you fight PCOS and lead a healthier and much happier life!

1. Work out Daily

Doing any sort of physical activity for at least 50 minutes daily helps you stay fit and healthy. A lot of toxins are released from your body while you are working out, cleansing your system in the process. It keeps you in good shape, de-stresses you and helps preserve the overall hormonal balance of your body. Exercise increases metabolism which increases the body’s ability to burn the food we eat.

2. Say goodbye to processed foods

Processed and oily food is a big no-no if you are suffering from PCOS. Switch over to unprocessed and whole foods as soon as you can. Food in its natural, unaltered form, especially with a lot of fibre in it, helps to lower the male hormones. Also, maintain a proper balance of proteins and carbohydrates in your daily intake of food.

3. Drink lots and lots of water

Keeping yourself hydrated all the time is the key to a fit and healthy lifestyle. Say no to aerated drinks and alcohol, and drink 3-4 litres of water per day, natural juices, and coconut water instead.

4. Replace coffee and tea with green tea

Tea and coffee are stimulants that have a drug-like effect on our body. And although they are harmless in moderate measure for others, they have quite a negative impact on women with PCOS and can further worsen their condition by reducing sleep which increases stress. You can always have green tea instead, as it is great for your immune system.

5. Relax

Taking too much stress can aggravate the symptoms of PCOS and further disturb your hormonal balance. Indulging in de-stressing activities like yoga and meditation can help calm you down. Take out some “me time” daily, in order to calm your mind and help your body relax.

6. Get quality sleep

Make a conscious effort to get adequate sleep for at least 5 to 6 hours every night and at the right time. Respect the biological clock which means – early to bed and early to rise. Avoid excess screen time, especially at night. More screen time at night leads to stress and weight gain.

Five diet changes that can drastically help reverse PCOS

Although there are specific medications to take care of PCOS, however, some changes in diet along with an active lifestyle can bring back normalcy in the way ovaries function and control these fluid-filled cysts. Let us take a look at 5 food changes that can help tackle Polycystic Ovaries at home.

1. Leafy Greens

Green leafy vegetables are a great natural source of vitamins K, C, E and B-vitamins besides providing iron, calcium, potassium, and magnesium. These vitamins and minerals, micronutrients like selenium, copper, magnesium are essential for hormonal balance and in managing PCOS.

2. Bright Vegetables

Foods rich in antioxidants help manage PCOS, therefore aim for including bright vegetables like red & yellow bell peppers, sweet potatoes, brinjals, beetroots, etc. Antioxidants fight the free radicals and reduce oxidative stress from the body.

3. Fruits + Yogurt or Fruits + Nuts + Seeds

Women suffering from PCOS need to be careful while consuming fruits that have a high glycemic index or sugars. The solution lies in combining fruits with protein in the form of yoghurt or nuts and seeds. The protein content in these additions helps absorb the instant blood sugar that fruits release. Also, gorge on low GI fruits like apples, pears, cherries, plums, grapefruit, coconut, kiwi, oranges, etc.

4. Avoid excess carbs

PCOS interferes with insulin function thereby stimulating the pancreas to produce more insulin, which wreaks havoc on the overall health and is the cause for weight gain too. Thereby, women with PCOS must take extra care of their insulin levels. Avoid refined carbs like refined flour, white rice, white bread, white pasta; restrict sugar consumption and ward off stress as much as you can to maintain healthy insulin levels.

5. Foods to Avoid

If you are suffering from Polycystic Ovaries, then you must avoid processed foods, canned juices, soda, high GI foods like mashed potatoes, corn, chips, cookies, candies, fruits with high sugars are bananas, custard apple, chikoo, mangoes, grapes etc.

Advice from one of the best gynaecologists in Hyderabad

“The first thing to start with is exercise rather than going on a diet plan. Once exercise becomes a routine, an additional diet plan will enrich the result of weight loss. Exercise also helps in releasing endorphins which are happy hormones which help in destressing”, says Dr Swarna Sree, one of the best gynaecologists of Zoi Hospitals, Somajiguda and Attapur.

Birth Control is also known as contraception or fertility control. It is a method or device used to prevent pregnancy. Birth Control has been used since ancient times, but effective and safe methods of birth control only became available in the 20th century.

Birth Control has several different options. While abstinence, or refraining from intercourse, is the only way to prevent pregnancy with 100 percent certainty, there are both non-hormonal and hormonal methods of contraception.

Why Birth Control?

Your choice of a birth control method depends on a number of factors, including your health, how often you have sex, and whether or not you want children. The use of contraception can significantly lower your chances of becoming pregnant. Some types of birth control can even lower your risk of contracting a sexually transmitted infection.

People choose to use contraception for many reasons. The main reasons include:

1. You may have decided that you don’t want to have children or maybe just not now.

2. You may choose to use contraception to help space the timing of the births of your children.

3. You may not have a stable partner to help in parenting a child.

4. You feel that, at this time in your life, you are not able to take on the financial responsibilities of having a baby.

5. You may be feeling like your family is complete, so you want to make sure that you don’t become pregnant again.

6. You do not feel ready to be a parent or feel that you are too young.

7. For health-related reasons, it may not be safe for you to have a baby.

What are the types of birth control?

As birth control is a way for men and women to prevent pregnancy, there are control options for both. The options for women include hormonal methods and non-hormonal methods. The options for men include temporary and permanent methods.

Non-hormonal methods generally create a physical barrier between the sperm and the egg. There are also two permanent methods requiring surgery: sterilization, or tubal ligation, for women, and vasectomy for men.

Hormonal methods generally make it less likely that a woman will release an egg, that an embryo will form, or that an embryo will be implanted.

Female Birth Control methods-

Non-hormonal:

1. Abstinence

Abstinence is the only birth control that is 100 percent effective and is also the best way to protect you against STDs.

2. Barrier Methods

They include the use of female condoms, spermicidal jelly, diaphragm or cervical cap.

The female condom is a thin tube of latex or other material that fits inside the vagina and blocks sperm. This method may prevent some STDs. It can be inserted up to eight hours in advance of intercourse.

Spermicidal jelly is used in the form of a round plastic sponge saturated with spermicide that fits in the vagina to block and kill sperm. It can be left in for multiple acts of intercourse in 24 hours.

A cervical cap is a soft, flexible covering that fits over the cervix to prevent sperm from entering the uterus. You need to fill it with spermicide before use. The cap is a possible option for you if you don’t want the hormonal effects of the pill, implant, shot, or patch. It can be left in for multiple acts of intercourse in 48 hours.

The diaphragm is a soft, flexible disk that blocks the cervix. You need to cover it with spermicide before use. The diaphragm is a possible option for you if you don’t want the hormonal effects of the pill, implant, shot, or patch. It can be left in for multiple acts of intercourse in 24 hours if you insert more spermicide every six hours.

Hormonal Methods:

1. Oral Contraceptive Pill

This pill uses estrogen and progestin to prevent ovaries from releasing eggs and helps prevent sperm from entering the uterus by thickening cervical mucus. Some women prefer the pill because they don’t like the idea of having a birth control method that has to be inserted or implanted. The pill can also reduce the severity of period symptoms.

2. Injections

An injection of the hormone progestin is given every 90 days in a doctor’s office. It prevents pregnancy by affecting ovulation and the uterine lining, and thickening cervical mucus. All you have to remember is your doctor’s appointment.

3. Implants

An implant is a plastic rod about half the size of a matchstick that’s placed under your skin, it releases the hormone progestin, which affects ovulation and makes cervical mucus thicker to block sperm. It is one of the most effective options available. It lasts up to three years but can be removed at any time.

4. Intrauterine Contraceptive Devices

Intrauterine devices (IUDs) are small T-shaped instruments that are placed in your uterus during a doctor visit and remain there for several years. There are two kinds of IUDs. The copper IUD prevents a fertilized egg from implanting in your uterus. The hormonal version is the second kind of IUD. It releases progestin, which affects ovulation and makes cervical mucus thicker to block sperm.

5. Emergency Contraception

Emergency contraception is a form of birth control that may be used by women within 120 hours (five days) of having unprotected sex. This may be necessary in the case of contraceptive failure (broken condom), rape, or any other situation where highly effective contraception was not available. It is most effective when taken soon after unprotected intercourse. A copper IUD is the most effective form of emergency contraception, and also provides ongoing birth control.

It also includes processes like Tubal ligation, a surgery to “tie the tubes” (fallopian tubes) of a woman. This causes permanent sterility by preventing transport of the egg (ovum) to the uterus. This also blocks the passage of sperm up the tube to the ovulating ovary where fertilization normally occurs.

Male Birth Control Options-

Temporary Methods:

1. Abstinence

Abstinence is the only birth control that is 100 percent effective and is also the best way to protect you against STDs.

2. Coitus Interruptus (Withdrawal methods)

These are not effective methods of birth control when used on their own. Out of every five women using these methods to prevent pregnancy, one will get pregnant by the end of the year.

3. Barrier Methods

The male condom, or “rubber,” is a thin covering made of latex, plastic or animal membrane that is rolled over an erect penis. The covering prevents semen – the fluid that contains sperm, from entering a woman’s vagina.

Permanent Methods:

4. Vasectomy

Vasectomy is an outpatient surgery in which the tubes that carry sperm are cut and sealed so no sperm are released during ejaculation. This method is one of the most effective methods of birth control. Although it is effective only after three months when a doctor has verified that no semen is passing into the ejaculate. While a vasectomy can be reversed, you should consider it a permanent birth control solution.

Benefits of Birth Control Methods

Hormonal birth control is a lifesaver for many women trying to prevent unwanted pregnancy. They balance the hormonal fluctuations that happen throughout your cycle. Of course, non-hormonal methods have their benefits too. But hormonal birth control, including the pill, IUDs, implants, and patches, offer a range of benefits beyond pregnancy prevention.

The benefits include:

1. It regulates the menstrual cycle

2. It makes periods less painful

3. It can banish hormonal acne

4. It reduces the risk of uterine cancer

5. It reduces the risk of ovarian cysts

6. It can relieve symptoms of PMS and PMDD

7. It helps to manage endometriosis

8. It can help with menstrual migraines

9. It gives the freedom to bleed on your own terms

10. It can reduce your risk of anaemia

Side-effects of Birth Control Methods

Hormonal birth control isn’t for everyone. If you smoke and are over the age of 435, it can increase your risk of blood clots and high blood pressure. In addition, some types of hormonal birth control, such as combination pills and the patch, can increase your risk of blood clots and high blood pressure, even in nonsmokers.

For some, hormonal birth control can also cause a range of physical and emotional symptoms, from joint pain to psychosis. When choosing a birth control option, make sure to tell your doctor about any side effects you’ve experienced with other methods you’ve tried.

Hormonal birth control also doesn’t protect against sexually transmitted infections. Unless you’re with a long-term partner and you’ve both been tested, make sure to use a condom or other protective barrier during sexual activity.

Advice from one of the best hospitals for gynaecology in Hyderabad

Gynaecologists in Zoi Hospitals, Somajiguda and Attapur say, “As you can see there are multiple birth control methods offered today and each one is very different. It is important that women explore their options and become knowledgeable about their choices before committing to a certain type.

Also, there is not a method that is absolutely 100% effective other than complete abstinence, which is not having sex. Most birth control methods do not protect against STD/HIV and hence it is important for patients to communicate any concerns or queries with their doctor.

Finally, every contraceptive method has its own pros and cons, so practice safely!”

From the day people know about your pregnancy, the joy gets doubled as both sides of the family and friends join to celebrate together. Pregnancy is a unique phase with lots of unique challenges.

Zoi Hospitals, Hyderabad is known for some of the best gynaecologists in Hyderabad. Gynaecologists in Somajiguda and Attapur have come together to write a detailed blog to make your pregnancy a wonderful and memorable phase while informing you the symptoms and stages of pregnancy.

A. Pregnancy Symptoms:

Not all moms-to-be experience the same symptoms when pregnant, and symptoms vary in severity. A woman will not necessarily experience the same symptoms in the same way in subsequent pregnancies as with her first pregnancy
Certain early signs, like the absence of menstruation and weight gain, are common to all pregnancies. Other possible early symptoms and signs of pregnancy include mood swings, increased urination, headaches, lower back pain, sore breasts, darkened areolas, fatigue, nausea often referred to as “morning sickness” and implantation bleeding.

How soon can early pregnancy symptoms be seen?

Some women may experience early signs and symptoms within the first few weeks of pregnancy i.e., the first trimester, while others may develop symptoms later on in the pregnancy. First signs of early pregnancy can be very similar to symptoms experienced prior to a menstrual period and hence a woman may not recognize the symptoms as related to pregnancy.

Read on to know more about various symptoms during pregnancy and how to identify them.

– Missed/Late period

A missed menstrual period is the hallmark symptom of pregnancy. Sometimes, the mild cramping and spotting experienced at the time of implantation of the fertilized egg in the uterus can be mistaken for a menstrual period. Women whose menstrual cycles are irregular may also not immediately notice the absence of a menstrual period. It is uncommon for signs and symptoms of pregnancy to appear before the missed period, but if a woman’s cycles are irregular, this may happen.

– Implantation bleeding or cramping

Mild bleeding or spotting may occur when the fertilized egg attaches to the uterine lining, anywhere from 6 to 12 days after fertilization. Mild cramping can also occur at this time. Implantation bleeding may sometimes be mistaken for a menstrual period, although it is usually much lighter than a regular period.

– Vaginal discharge

Some women may notice a thick, milky discharge from the vagina in early pregnancy. This occurs in the first weeks of pregnancy as the vaginal walls thicken. This discharge may occur throughout the pregnancy. If there is an unpleasant odour associated with the discharge, or if it is associated with burning and itching, this is a sign of a yeast or bacterial infection. You should contact your health-care professional if this occurs.

– Breast changes

Many women experience changes in the breasts as early as the first weeks of pregnancy. These changes can be felt as soreness, tenderness, heaviness, fullness, or a tingling sensation. The discomfort typically decreases after some weeks.

– Darkening of the areola

The areola, or the area around the nipple, may darken in colour.

– Fatigue

While this symptom is very nonspecific and may be related to numerous factors, pregnant women often describe feelings of fatigue, from the earliest weeks of pregnancy.

– Morning sickness, nausea, and vomiting

This is actually a misnomer because the nausea of pregnancy can occur at any time of day. Some women never experience morning sickness, while others have severe nausea. Its most typical onset is between the 2nd and 8th weeks of pregnancy. Most women experience relief from the symptoms around the 13th or 14th week, but others may have nausea persistent throughout the pregnancy (hyperemesis gravidarum).

– Sensitivity to certain smells

Certain smells may bring on nausea or even vomit early in pregnancy.

– Increased urination

Starting around the 6-8th week, some women will have more frequent urination due to hormonal changes. If other symptoms occur, such as burning on urination, you should see your health care professional make sure you are not suffering from a urinary tract infection.

– Dizziness or fainting

This is related to hormonal changes which affect the glucose levels or blood pressure. Dizziness, lightheadedness and feeling faint can occur in early pregnancy.

– Constipation

Hormone levels can also cause some women to have constipation in early pregnancy.

– Headaches

Headaches, as well, maybe related to changing hormone levels and may occur throughout pregnancy.

– Food aversions or cravings

Cravings may begin in early pregnancy and may last throughout the pregnancy. Likewise, food aversions (feeling nauseous or dislike for particular foods) can also occur.

– Back pain

Often considered more a symptom of late pregnancy, lower back pain can actually begin in the early stages of pregnancy. Women can experience some degree of back pain throughout pregnancy.

– Mood changes

Mood swings are relatively common during the first trimester of pregnancy due to changing hormone levels. They may also be related to stress or other factors.

– Shortness of breath

Increased oxygen demand by the body (to support a growing fetus) may leave some women feeling short of breath, although this symptom is more common in later stages of pregnancy.

B. How Soon Can You Know You Are Pregnant?

A missed period is often the first sign that you may be pregnant, but how do you know for sure?
Many women use home pregnancy tests to tell if they are pregnant; however, these tests are more likely to be accurate when used at least one week after a woman’s last period. If you take the test less than 7 days before your last menstrual period, it may give you a false result. If the test is positive, it is more likely that you actually are pregnant. However, if the test is negative, there is an increased chance that the test is wrong. Your doctor can do a blood test to detect pregnancy sooner than a home pregnancy test can.

C. The Three Stages Of Pregnancy:

Conception to about the 12th week of pregnancy marks the first trimester. The second trimester is from the 13th to 27th week of pregnancy, and the third trimester starts about 28 weeks and lasts until birth. This slide show will discuss what occurs to both the mother and baby during each trimester.

First Trimester:

At 4 weeks, your baby is developing: The nervous system (brain and spinal cord) has begun to form. The heart begins to form. Arm and leg buds begin to develop. Your baby is now an embryo and 1/25 of an inch long. At 8 weeks, the embryo begins to develop into a fetus. Fetal development is apparent.
The end of the first trimester is at about week 12. At this point in your baby’s development, the nerves and muscles begin to work together. Your baby can make a fist. The external sex organs show if your baby is a boy or girl. Eyelids close to protect the developing eyes. They will not open again until week 28. Head growth has slowed, and your baby is about 3 inches long and weighs almost an ounce.

Second Trimester:

Once you enter the second trimester you may find it easier than the first. Your nausea (morning sickness) and fatigue may lessen or go away completely. However, you will also notice more changes to your body. That “baby bump” will start to show as your abdomen expands with the growing baby. By the end of the second trimester, you will even be able to feel your baby move!

Your baby is about 4 to 5 inches long and weighs almost 3 ounces. At about 20 weeks in the second trimester, your baby continues to develop: Your baby is more active. You might feel movement or kicking. Your baby is covered by fine, feathery hair called lanugo and a waxy protective coating called vernix. Eyebrows, eyelashes, fingernails, and toenails have formed. Your baby can even scratch itself. Your baby can hear and swallow.

By 24 weeks, even more, changes occur for your growing baby-Taste buds form on your baby’s tongue. Footprints and fingerprints have formed. Hair begins to grow on your baby’s head. Your baby has a regular sleep cycle.

Third Trimester:

In the third and final trimester, you will notice more physical changes, including swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of a serious condition called preeclampsia.)
Tender breasts, which may leak a watery pre-milk called colostrum.
Your belly button may protrude.
The baby “dropping,” or moving lower in your abdomen.
Contractions, which can be a sign of real or false labour.
Other symptoms you may notice in the third trimester include shortness of breath, heartburn, and difficulty sleeping.
Finally, from 37 to 40 weeks the last stages of your baby’s development occur. By the end of 37 weeks, your baby is considered the full term. Your baby’s organs are capable of functioning on their own. As you near your due date, your baby may turn into a head-down position for birth.
Average birth weight is between 6 pounds 2 ounces to 9 pounds 2 ounces and the average length is 19 to 21 inches long. Most full-term babies fall within these ranges, but healthy babies come in many different weights and sizes.

D. Weight Gain In Pregnancy

If you are in the healthy weight range before becoming pregnant (BMI 18.5-24.9), ideally you should gain between 11.5 kg and 16 kg i.e., 1 to 1.5 kg in the first three months, 1.5 to 2 kg each month until you give birth. If you are above the healthy weight range, you should gain less.

E. Frequency Of Check-Ups During Pregnancy

For a healthy pregnancy, your doctor will probably want to see you on the following recommended schedule of prenatal visits:
– Weeks 4 to 28: 1 prenatal visit a month
– Weeks 28 to 36: 1 prenatal visit every 2 weeks

– Weeks 36 to 40: 1 prenatal visit every week
Be sure to stick to the schedule that your doctor suggests, even if life gets hectic. Prenatal care is important for both your health and your baby’s health. In fact, when a mother doesn’t get prenatal care, her baby is three times more likely to have a low birth weight. When your doctor checks you regularly, he or she can spot problems early and treat them so that you can have the healthiest pregnancy possible.

F. Risk Factors That May Require More Visits

A recommended schedule isn’t set in stone, although visiting a trusted hospital like Zoi Hospitals, the best gynaecology hospital in Hyderabad will help you avoid risks during pregnancy.

Gynaecologists in Hyderabad will decide how often to see you based on your individual health picture and will want to see you more often if you had any health problems before you became pregnant or if problems develop during your pregnancy. You also may need additional tests to ensure that you and your baby stay healthy.

You can also read: Importance of exercise during pregnancy and Health Advantages of Breastfeeding for Baby & Mother