Dandasana Explanation: Dandasana is the simplest form of sitting position on which many other asanas are based. Description: Sit with your legs straight and feet together and place the hands on the ground on either side of the body with fingers pointing forward. Make sure you breathe normally and have your eyes shut for concentration. It is advisable to sit in this posture for a little time before practicing other asanas based on Dandasana. Benefits: It relaxes a person's body and mind when over strained and exhausted. It also prepares a person for doing other asanas.
Asana
Benefits
a) Ardha Padmasana
Relaxes the body and mind. Improves concentration of mind and digestion.
b) Gorakshasana
Strengthens the reproductive organs, leg muscles, relieves sciatica and prevents hernia. Improves concentration and digestion. Relaxes the mind. Suitable for meditation.
c) Gomukhasana
Increases lung capacity.
d) Baddha-Hasta-Gomukhasana
Increases lung capacity. Strengthens the muscles of arms and shoulders and good for ailments of shoulder and elbow joints.
e) Vakrasana
Strengthens spine and its mobility, stimulates kidneys and liver. Improves neuralgic pains.
f) Ardha Matsyendrasana
Exercises spine & its muscles, stimulates liver, pancreas, spleen & kidneys and relieves constipation.
g) Paschimottanasana
Strengthens thigh and leg muscles, improves pancreas and kidney functions and relieves constipation and sciatica.
h) Gatyaatmak Paschimottanasana
Same as Paschimottanasana, improves appetite, abdominal fat is reduced, regulates menstrual cycle, sexual disorders are cured and stretches the whole spinal column.
i) Koormasana
Straightens the curved spine, regulates the sex glands, reproductive and excretory organs, people suffering from lack of energy, sexual and urinary disorders get relief.
j) Akarshana Dhanurasana
Energizes muscles and nerves of hands and legs.
Ardha Padmasana Explanation: Ardha means half and hence the name means half position adopted for Padmasana. As complete Padmasana is very difficult for beginners, many yoga teachers do make their students practice Ardha Padmasana for few days before they are able to sit in Padmasana with ease and comfort. Description: Sit in Dandasana, the simplest sitting position, fold the right knee, put the right ankle on to the left thigh and keep the left leg in the same straight position of Dandasana. As in Padmasana, keep the right hand on the folded right knee with the fingers in holy position like CHIN MUDRA or JNANA MUDRA. Make sure you breathe normally and concentrate with your eyes shut. It is advisable to sit in this position for a little longer time before practicing Padmasana and other asanas that are based on Padmasana.
Benefits: It relaxes a person's body and mind and prepares him or her for Padmasana and other asanas that are based on Padmasana. It also improves digestion and helps in concentration and relaxation of mind. It's very suitable for meditation and helps a person until he learns to do Padmasana with ease.Gorakshasana Explanation: This asana is a minor variant of Bhadrasana.Description: Sit in Dandasana position, fold your legs with knees as wide as possible and bring the feet in front of the groin. Keep the soles of the feet opposed and touching each other. Make sure you have your heels up and toes touching the ground. Hold the ankles with your opposite hands and keep the body straight. Close the eyes and concentrate on breathing or attain any of the gazing Mudras. A minor variant of this position is Moolabandhasana. Maintain the position as long as you feel comfortable and then revert to the basic asana. Do pranayama and one of the Mudras for 5 minutes after this asana. Benefits: It prevents development of hernia, relieves sciatica, strengthens leg muscles and tones up the reproductive organs. It improves concentration and helps relax the mind.Gomukhasana Explanation: 'Gomukha' means head of a cow. The legs assume a triangular form and the body in this position resembles the cow's head.Description: Sit in Dandasana position. Fold the left leg and let your left ankle touch the right buttock. Fold the right leg over the left, so that the right knee is on top of the left knee. Make the right ankle touch the left buttock. Sit straight without bending or twisting the spine. Place both the hands one over the other with the palms facing down towards the right knee. Close your eyes and sit in this position as long as you can and at the same time breathing normally. Benefits: Prepares one for Mulabandha position. It increases lung capacity, improves hernia and arthritis in knees, hips, ankles, shoulders, elbows and wrists. One can also meditate in this position.Caution: Persons with bleeding piles should not attempt this asana and the men should take care to see that the testicles are not squeezed in between the tightly closed thighs. Baddha Hasta Gomukhasana Explanation: This is a variation of Gomukhasana where the hands are clasped together on the back of chest. Description: Sit in Dandasana position. Fold the left leg until the left ankle touches the right buttock and fold the right leg over the left, so that the right knee is on top of the left knee and the right ankle touches the left buttock. Sit straight and raise the right arm over the head and fold it behind so that the right palm touches the middle of the back. Now fold the left arm behind the back and clasp the right hand with the left hand behind the back. Close the eyes and stay in this position as long as you can and do normal breathing. Benefits: It increases the lung capacity, improves hernia and arthritis in knees, hips, ankles, shoulders, elbows and wrists. Caution: Persons with bleeding hemorrhoids should not attempt this asana and the men should take care to see that the testicles are not squeezed in between the tightly closed thighs. Vakrasana Explanation: Vakrasana is taught before Ardhamatsyendrasana, as it's related to it, but easier to learn. 'Vakra' means 'twisted'. Here, the spine is twisted. Position: Sit in Dandasana position. Bend the right leg and place the right foot near the left knee. Place the right palm on the ground just behind the right buttock, with the fingers pointing backwards. Keep the left arm straight, push the right knee to the left with it and place the left palm on the ground near the right foot. Then, twist the head and shoulders to the right and then, backwards as far as possible. Stay in this position as long as you can and return to the starting position. Breathe normally while in this asana. While returning to Dandasana, first bring back the head and shoulders to the front and then stretch the right leg. Do the same motions on the other side to complete one round of the asana. You may do 5 to 10 rounds of this asana in a day. Benefits: Increases movement of the spine on its long axis. Strengthens the spinal muscles and stimulates the kidneys. It's beneficial to people suffering from neuritis and diseases of kidney and liver.Note: Obese persons should not attempt to place the palm on the ground, in front. Instead, the raised knee should support their weight. The palm placed behind should be in line with the spine if possible. Ardha Matsyendrasana Explanation: The great Hindu sage, Matsyendra developed the original Matsyendrasana. This asana. 'Ardha Matsyendrasana' is so called meaning half position of the original asana. This asana is quite close to Vakrasana mentioned earlier. Description: Start with Dandasana. Bend the left knee and bring the left foot under the right thigh until the ankle is near the anus. Raise the right knee up and bend it until the right foot rests on the ground next to the left knee at its outer aspect. Stretch the left arm across the right knee and hold the right great toe with the left hand. Then, while turning the whole trunk to the right, stretch the right arm behind the back until the right hand rests on the left thigh. Do normal breathing and stay in this position as long as you can. Slowly return to the original Dandasana while breathing out. Repeat this procedure on the other side and stay in that position for the same duration. Do at least five times on each side. Do meditation in Sukhasana for five minutes after Matsyendrasana or relax in Shavasana for five minutes. Benefits: In this position, the spine turns 90 degrees on its long axis. This asana stimulates the liver, spleen, kidneys and pancreas. Constipation is also relieved. It has been found to be very beneficial to patients of diabetes in the studies conducted by Vemana Yoga Research Institute, Hyderabad, India.Paschimottanasana (Ugrasana) Explanation: Bending forward over stretched legs in a sitting position. This asana is also called as Ugrasana. Description: Sit in Dandasana with both feet touching each other. Raise the arms straight up above the head while inhaling. Bend forward while exhaling until you touch feet/ankles with both hands. Then, hook the great toes with the index fingers and bend more at the pelvis and try to touch the knees with your forehead. Obese people may hold the calf muscles if they can't reach the toes. In this position, you may sit for 15-20 seconds while holding the breath or doing normal breathing. Raise the arms again above the head while inhaling and bring down the arms for a second round of Ugrasana while exhaling. About 10 to 20 rounds are adequate in a day. Benefits: Hamstrings, arms, shoulders and abdominal muscles get exercised. It helps digestive system, reproductive organs, adrenals, liver, spleen and kidney functions. Constipation, diabetes and sciatica are also relieved.Gatyatmak PaschimottanasanaExplanation: This is a dynamic form of Paschimottanasana where the whole body is exercised vigorously. This asana starts with Danadasana, then lie on the ground as in Shavasana, go to Dandasana again, come in to Paschimottanasana and return to Shavasana. Do this continuously. Description: Sit in Dandasana, raise both hands above the head while inhaling, lie back to get in to Shavasana while exhaling, raise up with both arms stretched above the head while inhaling and bend forward to Paschimottanasana while exhaling. Go back to the starting position of Dandasana while inhaling and return to Shavasana with arms stretched above the head all the while doing exhalation. This constitutes one round. Do 10 to 15 rounds per day vigorously. Benefits: Same as Paschimottanasana, improves appetite, abdominal fat is reduced, regulates menstrual cycle, sexual disorders are cured and stretches the whole spinal column.Koormasana Explanation: 'Koorma' in Sanskrit means a tortoise. It denotes lying on the back. Description: Sit in Dandasana position and spread your legs out as much as possible. While exhaling, bend forward, insert the hands under the knees and then while inhaling reach the buttocks with both the hands. Touch the ground with the forehead again while exhaling. Close your eyes and breathe normally. Sit in this position as long as you can and then return to Dandasana. Do this at least 3 to 4 times. Benefits: This exercise is excellent for the muscles of spine, back and legs. It improves slipped disc problems of spinal cord. It also improves the circulation to back, neck, head and functions of digestive organs, sexual organs and kidneys.Caution: Patients suffering from high blood pressure, cardiovascular diseases and peptic ulcers should not practice this asana.Akarshana DhanurasanaExplanation: 'Dhanu' in sanskrit is a bow. In this Dhanurasana the body resembles a stretched bow and the person looks as if he/she is firing an arrow from the bow. Description: Sit in Dandasana position. Hold the left great toe with left hand and the right great toe with right hand. While firmly holding the left great toe with the left thumb and ring finger, pull the left foot towards the left ear until it touches the ear. Then, release the left foot and repeat the same procedure with right foot on the other side. This position constitutes one round of the asana. Inhale while assuming the position and exhale while returning to Dandasana. 10 to 20 rounds of this asana in the morning and evening are adequate per day. Benefits: This procedure energizes the muscles and nerves of arms and legs.
personalmd.com/news
Kamis, 18 Desember 2008
Pregnancy Problems
Pregnancy can throw up many a complication or problem. Bleeding during pregnancy or even spotting during pregnancy is a condition that alarms women. This article examines some of the possible reasons for this. We also take a look at pregnancy problems such as ectopic pregnancy and chemical pregnancy. Read on to find out some common reasons for a miscarriage and your chances of pregnancy after this pregnancy complication. Diabetes during pregnancy has also been discussed in depth here.
Bleeding during pregnancy
Bleeding during pregnancy can have either serious or minor implications. The causes of pregnancy bleeding are many and the severity depends on the stage of the pregnancy it occurs in. Minor spotting during pregnancy can occur when the fertilized egg travels down the fallopian tubes and attaches itself to the lining of the uterus. This type of pregnancy bleeding is known as implantation bleeding. Spotting during early pregnancy can also be indicative of an infection. Another cause for pregnancy bleeding is a spontaneous miscarriage that means an end of the pregnancy. Ectopic pregnancy can also lead to bleeding in early pregnancy. It is common for some women to have light spotting during pregnancy. Not all bleeding during pregnancy is dangerous. Any bleeding or spotting in late pregnancy should be brought to the notice of your doctor immediately. The cause for this type of spotting in late pregnancy may be minor but it can be indicative of a more serious problem. It can mean that the placenta has detached itself from the uterine wall and may endanger the fetus. Another reason for bleeding in late pregnancy can be an inflamed cervix. Very late in pregnancy, bleeding is also a sign of labor.
Pregnancy problemA pregnancy problem that occurs to many women is high blood pressure. Taking your blood pressure regularly is one way to detect this pregnancy complication. Other pregnancy problems that can crop up:
no heart sounds
cramping
no fetal movement
spotting, blood clots
A common pregnancy problem is urinary tract infection. This happens due to the enlarged uterus slowing the flow of urine by pressing against the tubes. Such infections can lead to pregnancy complications such as preterm labor and premature rupture of the uterine membranes.
Ectopic pregnancy symptoms Ectopic pregnancies can be tubal, abdominal, ovarian, corneal or cervical. Most of the time, an ectopic pregnancy is a tubal pregnancy. The causes for tubal pregnancy are not fully known. But these conditions can be indicative of a higher risk for ectopic pregnancy.
Previous history of ectopic pregnancy
Infertility
Pelvic or abdominal surgery
Pelvic Inflammatory Disease (PID)
Symptoms of an ectopic pregnancy are abdominal pain, bleeding and weakness and dizziness. Ultrasound is used to detect this type of pregnancy. An ectopic pregnancy will require you to have surgical treatment done as soon as the diagnosis is done. Surgical procedures are followed in instances where the tube ruptures or there are other complications. Chemical treatment of tubal pregnancy is done in non-urgent cases so as to dissolve the pregnancy without any harm to the tubes and other organs. The efficacy of the chemical treatment is done by monitoring the HCG levels.
Pregnancy diabetesPregnancy diabetes is a type of diabetes that occurs during gestation and disappears after the delivery. Pregnancy is a situation when more insulin is required by the body. In the event that the pancreas does not produce them in adequate amount, diabetes occurs. After childbirth, the need for insulin comes back to normal levels and gestational diabetes disappears. But women who have had pregnancy diabetes run an increased risk of developing Type 2 diabetes later. This risk can be substantially reduced by maintaining a healthy body weight, exercise and diet. Pregnancy diabetes has no external symptoms and can be detected through screening and measuring the blood glucose values. Pregnancy diabetes can be suitably treated with a diet. Medication is sometimes used to treat pregnancy diabetes. If left unattended, pregnancy diabetes can result in babies born too large or with other complications like deformities and illnesses. It can result in toxaemia (blood poisoning) and high blood pressure for the mother. Babies of diabetic mothers are closely monitored after birth to rule out any abnormalities. Symptoms of gestational diabetes are:
Feeling of thirst
Frequent urination
Loss of weight
General weakness
Progesterone pregnancyProgesterone is used as a fertility drug or as supplements administered after ovulation. This hormone is also used in most forms of assisted reproductive technology (ART). Progesterone in pregnancy is given either as pills, injections, gels and sublingual capsules. Progesterone plays an important role in pregnancy by maintaining the functions of the placenta and fighting off unwanted cells near the womb. Progesterone in pregnancy plays the important role of preventing the uterus from any spasms or spontaneous movements. Strengthening the pelvic walls to prepare for labor is another important function of progesterone hormone in pregnancy. At the end of the pregnancy, progesterone levels secreted by the placenta drop. This leads to uterine contractions and subsequent labor.
Pregnancy after miscarriageNearly 15-20% of pregnancies result in a miscarriage, more so in the first three months. When miscarriages happen three or more times, it is referred to as repeated miscarriage or habitual abortion. Causes of miscarriage can be many:
Chromosomal problems can result in multiple pregnancy losses. The structure of the chromosome or the genetic material it carries may have a problem resulting in a miscarriage.
Uterine abnormalities such as a double uterus or one that is separated by a wall can result in miscarriages.
Hormonal imbalance, referred to as a luteal phase defect is usually the cause of a pregnancy resulting in a miscarriage. This happens when there is not enough progesterone to sustain a pregnancy.
At times, the mother's body sees the fetus as a foreign body and attacks it instead of accepting it. These can be the resultant of the immune difference between the mother and father.
Other factors that could result in a miscarriage could be thyroid problems, health conditions or exposure to chemicals or drugs or x rays.
Pregnancy after a miscarriage need not be a difficult process. The chances of a successful pregnancy after miscarriage are high. Once the cause of the miscarriage is determined, the future pregnancy can be undertaken with special monitoring. It is generally advised that you should go in for a complete physical examination for blood assay, genetic counseling and testing of reproductive organs. Those who have had repeated miscarriages can go into for ultrasound and hysteroscopy to visualize the reproductive organs and detect any structural problems of the uterus, if any.
Chemical pregnancyThese days the term chemical pregnancy is discussed often. What is a chemical pregnancy? It is a clinical term used to describe a pregnancy that is confirmed by a test but not by clinical signs. The blood HCG levels are low and it is believed that fertilization occurs and the egg attached itself to the uterine wall but the embryo doesn't develop. This blighted ovum is the cause of nearly half the miscarriages occurring in the first trimester.
targetwoman.com/articles/pregnancy-problem
Bleeding during pregnancy
Bleeding during pregnancy can have either serious or minor implications. The causes of pregnancy bleeding are many and the severity depends on the stage of the pregnancy it occurs in. Minor spotting during pregnancy can occur when the fertilized egg travels down the fallopian tubes and attaches itself to the lining of the uterus. This type of pregnancy bleeding is known as implantation bleeding. Spotting during early pregnancy can also be indicative of an infection. Another cause for pregnancy bleeding is a spontaneous miscarriage that means an end of the pregnancy. Ectopic pregnancy can also lead to bleeding in early pregnancy. It is common for some women to have light spotting during pregnancy. Not all bleeding during pregnancy is dangerous. Any bleeding or spotting in late pregnancy should be brought to the notice of your doctor immediately. The cause for this type of spotting in late pregnancy may be minor but it can be indicative of a more serious problem. It can mean that the placenta has detached itself from the uterine wall and may endanger the fetus. Another reason for bleeding in late pregnancy can be an inflamed cervix. Very late in pregnancy, bleeding is also a sign of labor.
Pregnancy problemA pregnancy problem that occurs to many women is high blood pressure. Taking your blood pressure regularly is one way to detect this pregnancy complication. Other pregnancy problems that can crop up:
no heart sounds
cramping
no fetal movement
spotting, blood clots
A common pregnancy problem is urinary tract infection. This happens due to the enlarged uterus slowing the flow of urine by pressing against the tubes. Such infections can lead to pregnancy complications such as preterm labor and premature rupture of the uterine membranes.
Ectopic pregnancy symptoms Ectopic pregnancies can be tubal, abdominal, ovarian, corneal or cervical. Most of the time, an ectopic pregnancy is a tubal pregnancy. The causes for tubal pregnancy are not fully known. But these conditions can be indicative of a higher risk for ectopic pregnancy.
Previous history of ectopic pregnancy
Infertility
Pelvic or abdominal surgery
Pelvic Inflammatory Disease (PID)
Symptoms of an ectopic pregnancy are abdominal pain, bleeding and weakness and dizziness. Ultrasound is used to detect this type of pregnancy. An ectopic pregnancy will require you to have surgical treatment done as soon as the diagnosis is done. Surgical procedures are followed in instances where the tube ruptures or there are other complications. Chemical treatment of tubal pregnancy is done in non-urgent cases so as to dissolve the pregnancy without any harm to the tubes and other organs. The efficacy of the chemical treatment is done by monitoring the HCG levels.
Pregnancy diabetesPregnancy diabetes is a type of diabetes that occurs during gestation and disappears after the delivery. Pregnancy is a situation when more insulin is required by the body. In the event that the pancreas does not produce them in adequate amount, diabetes occurs. After childbirth, the need for insulin comes back to normal levels and gestational diabetes disappears. But women who have had pregnancy diabetes run an increased risk of developing Type 2 diabetes later. This risk can be substantially reduced by maintaining a healthy body weight, exercise and diet. Pregnancy diabetes has no external symptoms and can be detected through screening and measuring the blood glucose values. Pregnancy diabetes can be suitably treated with a diet. Medication is sometimes used to treat pregnancy diabetes. If left unattended, pregnancy diabetes can result in babies born too large or with other complications like deformities and illnesses. It can result in toxaemia (blood poisoning) and high blood pressure for the mother. Babies of diabetic mothers are closely monitored after birth to rule out any abnormalities. Symptoms of gestational diabetes are:
Feeling of thirst
Frequent urination
Loss of weight
General weakness
Progesterone pregnancyProgesterone is used as a fertility drug or as supplements administered after ovulation. This hormone is also used in most forms of assisted reproductive technology (ART). Progesterone in pregnancy is given either as pills, injections, gels and sublingual capsules. Progesterone plays an important role in pregnancy by maintaining the functions of the placenta and fighting off unwanted cells near the womb. Progesterone in pregnancy plays the important role of preventing the uterus from any spasms or spontaneous movements. Strengthening the pelvic walls to prepare for labor is another important function of progesterone hormone in pregnancy. At the end of the pregnancy, progesterone levels secreted by the placenta drop. This leads to uterine contractions and subsequent labor.
Pregnancy after miscarriageNearly 15-20% of pregnancies result in a miscarriage, more so in the first three months. When miscarriages happen three or more times, it is referred to as repeated miscarriage or habitual abortion. Causes of miscarriage can be many:
Chromosomal problems can result in multiple pregnancy losses. The structure of the chromosome or the genetic material it carries may have a problem resulting in a miscarriage.
Uterine abnormalities such as a double uterus or one that is separated by a wall can result in miscarriages.
Hormonal imbalance, referred to as a luteal phase defect is usually the cause of a pregnancy resulting in a miscarriage. This happens when there is not enough progesterone to sustain a pregnancy.
At times, the mother's body sees the fetus as a foreign body and attacks it instead of accepting it. These can be the resultant of the immune difference between the mother and father.
Other factors that could result in a miscarriage could be thyroid problems, health conditions or exposure to chemicals or drugs or x rays.
Pregnancy after a miscarriage need not be a difficult process. The chances of a successful pregnancy after miscarriage are high. Once the cause of the miscarriage is determined, the future pregnancy can be undertaken with special monitoring. It is generally advised that you should go in for a complete physical examination for blood assay, genetic counseling and testing of reproductive organs. Those who have had repeated miscarriages can go into for ultrasound and hysteroscopy to visualize the reproductive organs and detect any structural problems of the uterus, if any.
Chemical pregnancyThese days the term chemical pregnancy is discussed often. What is a chemical pregnancy? It is a clinical term used to describe a pregnancy that is confirmed by a test but not by clinical signs. The blood HCG levels are low and it is believed that fertilization occurs and the egg attached itself to the uterine wall but the embryo doesn't develop. This blighted ovum is the cause of nearly half the miscarriages occurring in the first trimester.
targetwoman.com/articles/pregnancy-problem
Selasa, 16 Desember 2008
Definition
It seems simple. When you itch, you scratch. But itchy skin (pruritus) can have hundreds of possible causes. It may be the result of a rash or another itchy skin condition, such as psoriasis or dermatitis. Or itchy skin may be a symptom of an internal disease, such as liver disease or kidney failure. Though itchy, your skin may appear normal. Or it may be accompanied by redness, rough skin, bumps or blisters.
Symptoms
Itchy skin is an uncomfortable, irritating sensation that makes you want to scratch. It may occur in small areas, such as on an arm or leg. Or your whole body may feel itchy. Itchy skin can occur without any other noticeable changes on the skin. Or, it may be associated with:
Redness
Bumps, spots or blisters
Dry, cracked skin
Leathery or scaly texture to the skin
Sometimes itchy skin lasts a long time and becomes very intense. As you rub or scratch the area, it gets itchier. And the more it itches, the more you scratch. Breaking this itch-scratch cycle can be challenging.
Causes
Itchy skin that isn't accompanied by other obvious skin changes, such as a rash, is most often caused by dry skin (xerosis). Dry skin usually results from environmental factors that you can wholly or partially control. These include hot or cold weather with low humidity levels, long-term use of air conditioning or central heating, and washing or bathing too much.
Other conditions cause itchy skin as well. Skin disorders, internal diseases, allergies and drug reactions top the list.
Skin conditions and rashes. Many skin conditions cause itchy skin, including psoriasis, inflammation of the skin (dermatitis), scabies, lice, chickenpox and hives. In these cases, the itching usually affects specific areas and is accompanied by other signs, such as red, irritated skin or bumps and blisters.
Internal diseases. These include liver disease, malabsorption of wheat (celiac disease), kidney failure, iron deficiency anemia, thyroid problems and cancers, including leukemia and lymphoma. In these cases, the itching usually affects the whole body, rather than one specific area. The skin may look otherwise normal except for the scratched areas.
Irritation and allergic reactions. Wool, chemicals, soaps and other substances can irritate the skin and cause itching. Sometimes the substance causes an allergic reaction, such as in the case of poison ivy or cosmetics. Food allergies also may cause itchy skin reactions.
Drugs. Reactions to drugs, such as antibiotics, antifungal drugs or narcotic pain medications, can cause widespread rashes and itching.
Pregnancy. Some women experience itchy skin during pregnancy, especially on the abdomen, thighs, breasts and arms. Also, itchy skin conditions, such as dermatitis, can worsen during pregnancy.
Treatments and drugs
Once a cause is identified, treatments for itchy skin may include:
Medications. These include oral antihistamines for allergies or hives and corticosteroid creams for itching from skin inflammation.
Wet dressings. This involves applying medicated cream to affected areas and then covering these areas with damp cotton material that has been soaked in water or other solutions. The moisture in the wet dressings helps the skin absorb the medicated cream.
Treating the underlying disease. If an internal disease is found, whether it's kidney disease, iron deficiency or a thyroid problem, treating that disease often relieves the itch. Other itch-relief methods also may be recommended.
Light therapy (phototherapy). Phototherapy involves exposing your skin to certain wavelengths of ultraviolet light. Multiple sessions are usually scheduled until the itching is under control.
Although many types of itching respond well to treatment, itch relief may not be immediate. However, a number of creams and ointments are specifically designed to relieve itch. These include short-term use of topical anesthetics such as lidocaine or benzocaine and ointments and lotions such as menthol, camphor or calamine. Although these anti-itch products may immediately soothe your itch, treatment of the underlying cause is important for long-term relief.
mayoclinic.com/health/itchy-skin
It seems simple. When you itch, you scratch. But itchy skin (pruritus) can have hundreds of possible causes. It may be the result of a rash or another itchy skin condition, such as psoriasis or dermatitis. Or itchy skin may be a symptom of an internal disease, such as liver disease or kidney failure. Though itchy, your skin may appear normal. Or it may be accompanied by redness, rough skin, bumps or blisters.
Symptoms
Itchy skin is an uncomfortable, irritating sensation that makes you want to scratch. It may occur in small areas, such as on an arm or leg. Or your whole body may feel itchy. Itchy skin can occur without any other noticeable changes on the skin. Or, it may be associated with:
Redness
Bumps, spots or blisters
Dry, cracked skin
Leathery or scaly texture to the skin
Sometimes itchy skin lasts a long time and becomes very intense. As you rub or scratch the area, it gets itchier. And the more it itches, the more you scratch. Breaking this itch-scratch cycle can be challenging.
Causes
Itchy skin that isn't accompanied by other obvious skin changes, such as a rash, is most often caused by dry skin (xerosis). Dry skin usually results from environmental factors that you can wholly or partially control. These include hot or cold weather with low humidity levels, long-term use of air conditioning or central heating, and washing or bathing too much.
Other conditions cause itchy skin as well. Skin disorders, internal diseases, allergies and drug reactions top the list.
Skin conditions and rashes. Many skin conditions cause itchy skin, including psoriasis, inflammation of the skin (dermatitis), scabies, lice, chickenpox and hives. In these cases, the itching usually affects specific areas and is accompanied by other signs, such as red, irritated skin or bumps and blisters.
Internal diseases. These include liver disease, malabsorption of wheat (celiac disease), kidney failure, iron deficiency anemia, thyroid problems and cancers, including leukemia and lymphoma. In these cases, the itching usually affects the whole body, rather than one specific area. The skin may look otherwise normal except for the scratched areas.
Irritation and allergic reactions. Wool, chemicals, soaps and other substances can irritate the skin and cause itching. Sometimes the substance causes an allergic reaction, such as in the case of poison ivy or cosmetics. Food allergies also may cause itchy skin reactions.
Drugs. Reactions to drugs, such as antibiotics, antifungal drugs or narcotic pain medications, can cause widespread rashes and itching.
Pregnancy. Some women experience itchy skin during pregnancy, especially on the abdomen, thighs, breasts and arms. Also, itchy skin conditions, such as dermatitis, can worsen during pregnancy.
Treatments and drugs
Once a cause is identified, treatments for itchy skin may include:
Medications. These include oral antihistamines for allergies or hives and corticosteroid creams for itching from skin inflammation.
Wet dressings. This involves applying medicated cream to affected areas and then covering these areas with damp cotton material that has been soaked in water or other solutions. The moisture in the wet dressings helps the skin absorb the medicated cream.
Treating the underlying disease. If an internal disease is found, whether it's kidney disease, iron deficiency or a thyroid problem, treating that disease often relieves the itch. Other itch-relief methods also may be recommended.
Light therapy (phototherapy). Phototherapy involves exposing your skin to certain wavelengths of ultraviolet light. Multiple sessions are usually scheduled until the itching is under control.
Although many types of itching respond well to treatment, itch relief may not be immediate. However, a number of creams and ointments are specifically designed to relieve itch. These include short-term use of topical anesthetics such as lidocaine or benzocaine and ointments and lotions such as menthol, camphor or calamine. Although these anti-itch products may immediately soothe your itch, treatment of the underlying cause is important for long-term relief.
mayoclinic.com/health/itchy-skin
Sleep Well
CAN'T SLEEP?
Nothing is more frustrating than not being able to sleep. Tossing and turning. Your mind is racing, going over everything that happened today. Night noises keep you awake. What can you do? There ARE things you can do! Read on and learn some new tricks to sleep well. These tips are also known as "Sleep Hygiene."
Sleep only when sleepy This reduces the time you are awake in bed.
If you can't fall asleep within 20 minutes, get up and do something boring until you feel sleepy Sit quietly in the dark or read the warranty on your refrigerator. Don't expose yourself to bright light while you are up. The light gives cues to your brain that it is time to wake up.
Don't take naps This will ensure you are tired at bedtime. If you just can't make it through the day without a nap, sleep less than one hour, before 3 pm.
Get up and go to bed the same time every day Even on weekends! When your sleep cycle has a regular rhythm, you will feel better.
Refrain from exercise at least 4 hours before bedtime Regular exercise is recommended to help you sleep well, but the timing of the workout is important. Exercising in the morning or early afternoon will not interfere with sleep.
Develop sleep rituals It is important to give your body cues that it is time to slow down and sleep. Listen to relaxing music, read something soothing for 15 minutes, have a cup of caffeine free tea, do relaxation exercises.
Only use your bed for sleeping Refrain from using your bed to watch TV, pay bills, do work or reading. So when you go to bed your body knows it is time to sleep. Sex is the only exception.
Stay away from caffeine, nicotine and alcohol at least 4-6 hours before bed Caffeine and nicotine are stimulants that interfere with your ability to fall asleep. Coffee, tea, cola, cocoa, chocolate and some prescription and non-prescription drugs contain caffeine. Cigarettes and some drugs contain nicotine. Alcohol may seem to help you sleep in the beginning as it slows brain activity, but you will end end up having fragmented sleep.
Have a light snack before bed If your stomach is too empty, that can interfere with sleep. However, if you eat a heavy meal before bedtime, that can interfere as well. Dairy products and turkey contain tryptophan, which acts as a natural sleep inducer. Tryptophan is probably why a warm glass of milk is sometimes recommended.
Take a hot bath 90 minutes before bedtime
A hot bath will raise your body temperature, but it is the drop in body temperature that may leave you feeling sleepy. Read about the study done on body temperature below.
Trouble Sleeping? Chill Out! - A press release from the journal Sleep about the significance in body temperature before sleep
Make sure your bed and bedroom are quiet and comfortable A hot room can be uncomfortable. A cooler room along with enough blankets to stay warm is recommended. If light in the early morning bothers you, get a blackout shade or wear a slumber mask. If noise bothers you, wear earplugs or get a "white noise" machine.
Use sunlight to set your biological clock
As soon as you get up in the morning, go outside and turn your face to the sun for 15 minutes.
Nothing is more frustrating than not being able to sleep. Tossing and turning. Your mind is racing, going over everything that happened today. Night noises keep you awake. What can you do? There ARE things you can do! Read on and learn some new tricks to sleep well. These tips are also known as "Sleep Hygiene."
Sleep only when sleepy This reduces the time you are awake in bed.
If you can't fall asleep within 20 minutes, get up and do something boring until you feel sleepy Sit quietly in the dark or read the warranty on your refrigerator. Don't expose yourself to bright light while you are up. The light gives cues to your brain that it is time to wake up.
Don't take naps This will ensure you are tired at bedtime. If you just can't make it through the day without a nap, sleep less than one hour, before 3 pm.
Get up and go to bed the same time every day Even on weekends! When your sleep cycle has a regular rhythm, you will feel better.
Refrain from exercise at least 4 hours before bedtime Regular exercise is recommended to help you sleep well, but the timing of the workout is important. Exercising in the morning or early afternoon will not interfere with sleep.
Develop sleep rituals It is important to give your body cues that it is time to slow down and sleep. Listen to relaxing music, read something soothing for 15 minutes, have a cup of caffeine free tea, do relaxation exercises.
Only use your bed for sleeping Refrain from using your bed to watch TV, pay bills, do work or reading. So when you go to bed your body knows it is time to sleep. Sex is the only exception.
Stay away from caffeine, nicotine and alcohol at least 4-6 hours before bed Caffeine and nicotine are stimulants that interfere with your ability to fall asleep. Coffee, tea, cola, cocoa, chocolate and some prescription and non-prescription drugs contain caffeine. Cigarettes and some drugs contain nicotine. Alcohol may seem to help you sleep in the beginning as it slows brain activity, but you will end end up having fragmented sleep.
Have a light snack before bed If your stomach is too empty, that can interfere with sleep. However, if you eat a heavy meal before bedtime, that can interfere as well. Dairy products and turkey contain tryptophan, which acts as a natural sleep inducer. Tryptophan is probably why a warm glass of milk is sometimes recommended.
Take a hot bath 90 minutes before bedtime
A hot bath will raise your body temperature, but it is the drop in body temperature that may leave you feeling sleepy. Read about the study done on body temperature below.
Trouble Sleeping? Chill Out! - A press release from the journal Sleep about the significance in body temperature before sleep
Make sure your bed and bedroom are quiet and comfortable A hot room can be uncomfortable. A cooler room along with enough blankets to stay warm is recommended. If light in the early morning bothers you, get a blackout shade or wear a slumber mask. If noise bothers you, wear earplugs or get a "white noise" machine.
Use sunlight to set your biological clock
As soon as you get up in the morning, go outside and turn your face to the sun for 15 minutes.
Heart Attack
What Is a Heart Attack?
A heart attack occurs when blood flow to a section of heart muscle becomes blocked. If the flow of blood isn’t restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die.
Heart attack is a leading killer of both men and women in the United States. But fortunately, today there are excellent treatments for heart attack that can save lives and prevent disabilities. Treatment is most effective when started within 1 hour of the beginning of symptoms. If you think you or someone you’re with is having a heart attack, call 9–1–1 right away.
Overview
Heart attacks occur most often as a result of a condition called coronary artery disease (CAD). In CAD, a fatty material called plaque (plak) builds up over many years on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery.
Heart With Muscle Damage and a Blocked Artery
Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot.
During a heart attack, if the blockage in the coronary artery isn’t treated quickly, the heart muscle will begin to die and be replaced by scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
Severe problems linked to heart attack can include heart failure and life-threatening arrhythmias (irregular heartbeats). Heart failure is a condition in which the heart can’t pump enough blood throughout the body. Ventricular fibrillation is a serious arrhythmia that can cause death if not treated quickly.
Get Help Quickly
Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment is most effective when started within 1 hour of the beginning of symptoms.
The most common heart attack signs and symptoms are:
Chest discomfort or pain—uncomfortable pressure, squeezing, fullness, or pain in the center of the chest that can be mild or strong. This discomfort or pain lasts more than a few minutes or goes away and comes back.
Upper body discomfort in one or both arms, the back, neck, jaw, or stomach.
Shortness of breath may occur with or before chest discomfort.
Other signs include nausea (feeling sick to your stomach), vomiting, lightheadedness or fainting, or breaking out in a cold sweat.
If you think you or someone you know may be having a heart attack:
Call 9–1–1 within a few minutes—5 at the most—of the start of symptoms.
If your symptoms stop completely in less than 5 minutes, still call your doctor.
Only take an ambulance to the hospital. Going in a private car can delay treatment.
Take a nitroglycerin pill if your doctor has prescribed this type of medicine.
Outlook
Each year, about 1.1 million people in the United States have heart attacks, and almost half of them die. CAD, which often results in a heart attack, is the leading killer of both men and women in the United States.
Many more people could recover from heart attacks if they got help faster. Of the people who die from heart attacks, about half die within an hour of the first symptoms and before they reach the hospital.
nhlbi.nih.gov/health/dci/diseases/heartattack
A heart attack occurs when blood flow to a section of heart muscle becomes blocked. If the flow of blood isn’t restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die.
Heart attack is a leading killer of both men and women in the United States. But fortunately, today there are excellent treatments for heart attack that can save lives and prevent disabilities. Treatment is most effective when started within 1 hour of the beginning of symptoms. If you think you or someone you’re with is having a heart attack, call 9–1–1 right away.
Overview
Heart attacks occur most often as a result of a condition called coronary artery disease (CAD). In CAD, a fatty material called plaque (plak) builds up over many years on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery.
Heart With Muscle Damage and a Blocked Artery
Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot.
During a heart attack, if the blockage in the coronary artery isn’t treated quickly, the heart muscle will begin to die and be replaced by scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
Severe problems linked to heart attack can include heart failure and life-threatening arrhythmias (irregular heartbeats). Heart failure is a condition in which the heart can’t pump enough blood throughout the body. Ventricular fibrillation is a serious arrhythmia that can cause death if not treated quickly.
Get Help Quickly
Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment is most effective when started within 1 hour of the beginning of symptoms.
The most common heart attack signs and symptoms are:
Chest discomfort or pain—uncomfortable pressure, squeezing, fullness, or pain in the center of the chest that can be mild or strong. This discomfort or pain lasts more than a few minutes or goes away and comes back.
Upper body discomfort in one or both arms, the back, neck, jaw, or stomach.
Shortness of breath may occur with or before chest discomfort.
Other signs include nausea (feeling sick to your stomach), vomiting, lightheadedness or fainting, or breaking out in a cold sweat.
If you think you or someone you know may be having a heart attack:
Call 9–1–1 within a few minutes—5 at the most—of the start of symptoms.
If your symptoms stop completely in less than 5 minutes, still call your doctor.
Only take an ambulance to the hospital. Going in a private car can delay treatment.
Take a nitroglycerin pill if your doctor has prescribed this type of medicine.
Outlook
Each year, about 1.1 million people in the United States have heart attacks, and almost half of them die. CAD, which often results in a heart attack, is the leading killer of both men and women in the United States.
Many more people could recover from heart attacks if they got help faster. Of the people who die from heart attacks, about half die within an hour of the first symptoms and before they reach the hospital.
nhlbi.nih.gov/health/dci/diseases/heartattack
Headache
What is a headache?
Headache is defined as pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes.
How are headaches classified?
Headaches have numerous causes, and in 2007 the International Headache Society agreed upon an updated classification system for headache. Because so many people suffer from headaches, and because treatment is sometimes difficult, the new classification system allows health care practitioners to understand a specific diagnosis more completely to provide better and more effective treatment regimens.
There are three major categories of headaches:
primary headaches,
secondary headaches, and
cranial neuralgias, facial pain, and other headaches
What are primary headaches?
Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache.
Tension headaches are the most common type of primary headache; as many as 90% of adults have had or will have tension headaches. Tension headaches are more common among women than men.
Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience migraine headaches. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. An estimated 6% of men and up to 18% of women will experience a migraine headache.
Cluster headaches are a rare type of primary headache, affecting 0.1% of the population. An estimated 85% of cluster headache sufferers are men. The average age of cluster headache sufferers is 28-30 years of age, although headaches may begin in childhood.
Primary headaches affect quality of life. Some people have occasional headaches that resolve quickly, while others are debilitated. Tension, migraine, and cluster headaches are not life-threatening.
What are secondary headaches?
Secondary headaches are those that are due to an underlying structural problem in the head or neck. There are numerous causes of this type of headache ranging from bleeding in the brain, tumor, or meningitis and encephalitis.
medicinenet.com/headache
Headache is defined as pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes.
How are headaches classified?
Headaches have numerous causes, and in 2007 the International Headache Society agreed upon an updated classification system for headache. Because so many people suffer from headaches, and because treatment is sometimes difficult, the new classification system allows health care practitioners to understand a specific diagnosis more completely to provide better and more effective treatment regimens.
There are three major categories of headaches:
primary headaches,
secondary headaches, and
cranial neuralgias, facial pain, and other headaches
What are primary headaches?
Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache.
Tension headaches are the most common type of primary headache; as many as 90% of adults have had or will have tension headaches. Tension headaches are more common among women than men.
Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience migraine headaches. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. An estimated 6% of men and up to 18% of women will experience a migraine headache.
Cluster headaches are a rare type of primary headache, affecting 0.1% of the population. An estimated 85% of cluster headache sufferers are men. The average age of cluster headache sufferers is 28-30 years of age, although headaches may begin in childhood.
Primary headaches affect quality of life. Some people have occasional headaches that resolve quickly, while others are debilitated. Tension, migraine, and cluster headaches are not life-threatening.
What are secondary headaches?
Secondary headaches are those that are due to an underlying structural problem in the head or neck. There are numerous causes of this type of headache ranging from bleeding in the brain, tumor, or meningitis and encephalitis.
medicinenet.com/headache
Pregnancy
Pregnancy (latin graviditas) is the carrying of one or more offspring, known as a fetus or embryo, inside the uterus of a female. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets. Human pregnancy is the most studied of all mammalian pregnancies. Obstetrics is the surgical field that studies and cares for high risk pregnancy. Midwifery is the non-surgical field that cares for pregnancy and pregnant women.
Childbirth usually occurs about 38 weeks after fertilization (conception), i.e., approximately 40 weeks from the the last normal menstrual period (LNMP) in humans. The date of delivery is considered normal medically if it falls within two weeks of the calculated date. The calculation of this date involves the assumption of a regular 28-day period. Thus, pregnancy lasts almost nine months, although the exact definition of the English word “pregnancy” is a subject of controversy.
Terminology
One scientific term for the state of pregnancy is gravid, and a pregnant female is sometimes referred to as a gravida.[1] Both words are rarely used in common speech. Similarly, the term "parity" (abbreviated as "para") is used for the number of previous successful live births. Medically, a woman who is not currently pregnant or who has never been pregnant is referred to as a "nulligravida", and in subsequent pregnancies as "multigravida" or "multiparous".[2] Hence during a second pregnancy a woman would be described as "gravida 2, para 1" and upon delivery as "gravida 2, para 2". Incomplete pregnancies of abortions, miscarriages or stillbirths account for parity values being less than the gravida number, whereas a multiple birth will increase the parity value. Women who have never carried a pregnancy achieving more than 20 weeks of gestation age are referred to as "nulliparous".[3]
The term embryo is used to describe the developing offspring during the first eight weeks following conception, and the term fetus is used from about two months of development until birth.[4][5]
In many societies' medical and legal definitions, human pregnancy is somewhat arbitrarily divided into three trimester periods, as a means to simplify reference to the different stages of prenatal development. The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus). During the second trimester, the development of the fetus can be more easily monitored and diagnosed. The beginning of the third trimester often approximates the point of viability, or the ability of the fetus to survive, with or without medical help, outside of the uterus.[6]
[edit] Characteristics
Pregnancy occurs as the result of the female gamete or oocyte (egg) being penetrated by the male gamete spermatozoon in a process referred to, in medicine, as "fertilization", or more commonly known as "conception". The fusion of male and female gametes usually occurs through the act of sexual intercourse. However, the advent of artificial insemination has also made achieving pregnancy possible in such cases where sexual intercourse is not potentially fertile (through choice or male/female infertility).
A number of medical signs are associated with pregnancy.[7][8] These signs typically appear, if at all, within the first few weeks after conception. Although not all of these signs are universally present, nor are all of them diagnostic by themselves, taken together they make a presumptive diagnosis of pregnancy. These signs include the presence of human chorionic gonadotropin (hCG) in the blood and urine, missed menstrual period, implantation bleeding that occurs at implantation of the embryo in the uterus during the third or fourth week after last menstrual period, increased basal body temperature sustained for over two weeks after ovulation, Chadwick's sign (darkening of the cervix, vagina, and vulva), Goodell's sign (softening of the vaginal portion of the cervix), Hegar's sign (softening of the uterus isthmus), and pigmentation of linea alba - Linea nigra, (darkening of the skin in a midline of the abdomen, caused by hyperpigmentation resulting from hormonal changes; it usually appears around the middle of pregnancy).[7][8]
[edit] Duration
The expected date of delivery (EDD) is 40 weeks counting from the last menstrual period (LMP) and usually lasts between 37 and 42 weeks,[9] The actual pregnancy duration is typically 38 weeks after conception. Though pregnancy begins at conception, it is more convenient to date from the first day of a woman's last menstrual period, or from the date of conception if known. Starting from one of these dates, the expected date of delivery can be calculated. 40 weeks is nine months and six days, which forms the basis of Naegele's rule for estimating date of delivery. More accurate algorithms which take into account other variables, such as whether this is the first or subsequent child (i.e. mother is a primip or a multip, respectively), ethnicity, parental age, length of menstrual cycle and menstrual regularity form the basis for more sophisticated online calculation methods.
Pregnancy is considered 'at term' when gestation attains 37 complete weeks but is less than 42 (between 259 and 294 days since LMP). Events before completion of 37 weeks (259 days) are considered pre-term; from week 42 (294 days) events are considered post-term.[10] When a pregnancy exceeds 42 weeks (294 days), the risk of complications for mother and fetus increases significantly.[9][11] As such, obstetricians usually prefer to induce labour, in an uncomplicated pregnancy, at some stage between 41 and 42 weeks.[12][13]
Recent medical literature prefers the terminology pre-term and post-term to premature and post-mature. Pre-term and post-term are unambiguously defined as above, whereas premature and postmature have historical meaning and relate more to the infant's size and state of development rather than to the stage of pregnancy.[14][15]
Fewer than 5% of births occur on the due date; 50% of births are within a week of the due date, and almost 90% within two weeks.[16] It is much more useful to consider therefore a range of due dates, rather than one specific day, with some online due date calculators providing this information.
Accurate dating of pregnancy is important, because it is used in calculating the results of various prenatal tests (for example, in the triple test). A decision may be made to induce labour if a fetus is perceived to be overdue. Furthermore, if a difference of predicted due date is highlighted between dates based on LMP and ultrasound dating, with the latter being later, this might signify slowed fetal growth and therefore the need for closer review.
[edit] Diagnosis
Main article: Obstetrics
The beginning of pregnancy may be detected in a number of ways, including various pregnancy tests which detect hormones generated by the newly-formed placenta. Clinical blood and urine tests can detect pregnancy soon after implantation, which is as early as 6-8 days after fertilization. Home pregnancy tests are personal urine tests, which normally cannot detect a pregnancy until at least 12-15 days after fertilization. Both clinical and home tests can only detect the state of pregnancy, and cannot detect the age of the embryo.
In the post-implantation phase, the blastocyst secretes a hormone named human chorionic gonadotropin which in turn, stimulates the corpus luteum in the woman's ovary to continue producing progesterone. This acts to maintain the lining of the uterus so that the embryo will continue to be nourished. The glands in the lining of the uterus will swell in response to the blastocyst, and capillaries will be stimulated to grow in that region. This allows the blastocyst to receive vital nutrients from the woman.
Despite all the signs, some women will not realize they are pregnant until they are quite far along in their pregnancy, sometimes not until they are nearing the time of their birth. This can be caused by many factors, namely irregular periods (quite common in teenage pregnancies), or heavily over weight or obese women who do not notice their weight gain. Teenagers in developing countries who have no sexual education what so ever, won't even know they are pregnant until the day they give birth, despite their large abdomen growth[citation needed].
An early sonograph can determine the age of the pregnancy fairly accurately. In practice, doctors typically express the age of a pregnancy (i.e. an "age" for an embryo) in terms of "menstrual date" based on the first day of a woman's last menstrual period, as the woman reports it. Unless a woman's recent sexual activity has been limited, or she has been charting her cycles, or the conception is as the result of some types of fertility treatment (such as IUI or IVF) the exact date of fertilization is unknown. Absent symptoms such as morning sickness, often the only visible sign of a pregnancy is an interruption of her normal monthly menstruation cycle, (i.e. a "late period"). Hence, the "menstrual date" is simply a common educated estimate for the age of a fetus, which is an average of two weeks later than the first day of the woman's last menstrual period. The term "conception date" may sometimes be used when that date is more certain, though even medical professionals can be imprecise with their use of the two distinct terms. The due date can be calculated by using Naegele's rule. The expected date of delivery may also be calculated from sonogram measurement of the fetus. This method is slightly more accurate than methods based on LMP.[17] The beginning of labour, which is variously called confinement or childbed, begins on the day predicted by LMP 3.6% of the time and on the day predicted by sonography 4.3% of the time.[18]
Diagnostic criteria are: Women who have menstrual cycles and are sexually active, a period delayed by a few days or weeks is suggestive of pregnancy; elevated B-hcG to around 100,000 mIU/mL by 10 weeks of gestation.[1]
[edit] Physiology
The term trimester redirects here. For the term trimester used in academic settings, see Academic term
Pregnancy is typically broken into three periods, or trimesters, each of about three months. While there are no hard and fast rules, these distinctions are useful in describing the changes that take place over time.
[edit] First trimester
Comparison of growth of the abdomen between 26 weeks and 40 weeks gestation.
Traditionally, doctors have measured pregnancy from a number of convenient points, including the day of last menstruation, ovulation, fertilization, implantation and chemical detection. In medicine, pregnancy is often defined as beginning when the developing embryo becomes implanted into the endometrial lining of a woman's uterus. In some cases where complications may have arisen, the fertilized egg might implant itself in the fallopian tubes or the cervix, causing an ectopic pregnancy. Most pregnant women do not have any specific signs or symptoms of implantation, although it is not uncommon to experience light bleeding at implantation. Some women will also experience cramping during their first trimester. This is usually of no concern unless there is spotting or bleeding as well. The outer layers of the embryo grow and form a placenta, for the purpose of receiving essential nutrients through the uterine wall, or endometrium. The umbilical cord in a newborn child consists of the remnants of the connection to the placenta. The developing embryo undergoes tremendous growth and changes during the process of foetal development.
Morning sickness can occur in about seventy percent of all pregnant women and typically improves after the first trimester.[19] Most miscarriages occur during this period.
A pregnant woman at 26 weeks
[edit] Second trimester
Months 4 through 6 of the pregnancy are called the second trimester. Most women feel more energized in this period, and begin to seriously put on weight as the symptoms of morning sickness subside and eventually fade away. Although the fetus begins moving and takes a recognizable human shape during the first trimester, it is not until the second trimester that movement of the fetus, often referred to as "quickening", can be felt. This typically happens in the fourth month more specifically in the 20 to 21 week or by the 18th week if you've been pregnant before. However, it is not uncommon for some women to not feel the baby move until much later. The placenta is now fully functioning and the fetus is making insulin and urinating. The reproductive organs can be recognized, and can distinguish the fetus as male or female.
[edit] Third trimester
Final weight gain takes place, which is the most weight gain throughout the pregnancy. The fetus will be growing the most rapidly during this stage, gaining up to 28g per day. The woman's belly will transform in shape as the belly drops due the the fetus turning in a downward position ready for birth. During the second trimester, the woman's belly would have been very upright, whereas in the third trimester it will drop down quite low, the woman will be able to lift her belly up and down. The fetus begins to move regularly, and is felt by the woman. Fetal movement can become quite strong and be disruptive to the woman. The woman's navel will sometimes become convex, "popping" out, due to her expanding abdomen. This period of her pregnancy can be uncomfortable, causing symptoms like weak bladder control and back-ache. Movement of the fetus becomes stronger and more frequent and via improved brain, eye, and muscle function the fetus is prepared for ex utero viability. The woman can feel the fetus "rolling" and it may cause pain or discomfort when it is near the woman's ribs and spine.
It is during this time that a baby born prematurely may survive. The use of modern medical intensive care technology has greatly increased the probability of premature babies surviving, and has pushed back the boundary of viability to much earlier dates than would be possible without assistance.[20] In spite of these developments, premature birth remains a major threat to the fetus, and may result in ill-health in later life, even if the baby survives.
[edit] Prenatal development and sonograph images
See also: Prenatal development
Prenatal development is divided into two primary biological stages. The first is the embryonic stage, which lasts for about two months. At this point, the fetal stage begins. At the beginning of the foetal stage, the risk of miscarriage decreases sharply,[21] all major structures including hands, feet, head, brain, and other organs are present, and they continue to grow and develop. When the fetal stage commences, a fetus is typically about 30 mm (1.2 inches) in length, and the heart can be seen beating via sonograph; the fetus bends the head, and also makes general movements and startles that involve the whole body.[22] Some fingerprint formation occurs from the beginning of the fetal stage.[23]
Electrical brain activity is first detected between the 5th and 6th week of gestation, though this is still considered primitive neural activity rather than the beginning of conscious thought, something that develops much later in fetation. Synapses begin forming at 17 weeks, and at about week 28 begin multiply at a rapid pace which continues until 3-4 months after birth. It isn't until week 23 that the fetus can survive, albeit with major medical support, outside of the womb. It is not until then that the fetus possesses a sustainable human brain. [24]
Embryo at 6 weeks after fertilization[25]
Fetus at 8 weeks after fertilization[26]
Fetus at 18 weeks after fertilization[27]
Fetus at 38 weeks after fertilization[28]
Relative size in 1st month (simplified illustration)
Relative size in 3rd month (simplified illustration)
Relative size in 5th month (simplified illustration)
Relative size in 9th month (simplified illustration)
One way to observe prenatal development is via ultrasound images. Modern 3D ultrasound images provide greater detail for prenatal diagnosis than the older 2D ultrasound technology.[29] Whilst 3D is popular with parents desiring a prenatal photograph as a keepsake,[30] both 2D and 3D are discouraged by the FDA for non-medical use,[31] but there are no definitive studies linking ultrasound to any adverse medical effects.[32] The following 3D ultrasound images were taken at different stages of pregnancy:
3-inch fetus (about 14 weeks gestational age)
Fetus at 17 weeks
Fetus at 20 weeks
[edit] Physiological changes in pregnancy
The body must change its physiological and homeostatic mechanisms in pregnancy to ensure the fetus is provided for. Increases in blood sugar, breathing and cardiac output are all required.
[edit] Hormonal changes
Levels of progesterone and oestrogens rise continually throughout pregnancy, suppressing the hypothalamic axis and subsequently the menstrual cycle. The mother and the placenta also produces many hormones.
Prolactin levels increase due to maternal Pituitary gland enlargement by 50%. This mediates a change in the structure of the Mammary gland from ductal to lobular-alveolar. Parathyroid hormone is increased due to increases of calcium uptake in the gut and reabsorption by the kidney. Adrenal hormones such as cortisol and aldosterone also increase.
Placental lactogen is produced by the placenta and stimulates lipolysis and fatty acid metabolism by the mother, conserving blood glucose for use by the fetus. It also decreases maternal tissue sensitivity to insulin, resulting in gestational diabetes.
[edit] Musculoskeletal changes
The body's posture changes as the pregnancy progresses. The pelvis tilts and the back arches to help keep balance. Poor posture occurs naturally from the stretching of the woman's abdominal muscles as the baby grows. These muscles are less able to contract and keep the lower back in proper alignment. The pregnant woman has a different pattern of gait. The step lengthens as the pregnancy progresses, due to weight gain and changes in posture. On average, a woman's foot can grow by a half size or more during pregnancy. In addition, the increased body weight of pregnancy, fluid retention, and weight gain lowers the arches of the foot, further adding to the foot's length and width. The influences of increased hormones such as estrogen and relaxin initiate the remodeling of soft tissues, cartilage and ligaments. Certain skeletal joints such as the symphysis pubis and sacroiliac widen or have increased laxity.
[edit] Physical changes
Weight is gained during pregnancy due to increased appetite, fat deposition, and growth of the reproductive organs and fetus, as well as increased blood volume and water retention. Anywhere from 5 to over 100 pounds can be gained during pregnancy. In America, the doctor-recommended weight gain range is 25-35 pounds, less if the woman is overweight, more (up to 40) if the woman is underweight.
[edit] Cardiovascular changes
Blood volume increases by 40% in the first two trimesters. This is due to an increase in plasma volume through increased aldosterone. Progesterone may also interact with the aldosterone receptor, thus leading to increased levels. Red blood cell numbers increase due to increased erythropoietin levels.
Cardiac function is also modified, with increase heart rate and increased stroke volume. A decrease in vagal tone and increase in sympathetic tone is the cause. Blood volume increases act to increase stroke volume of the heart via Starling's law. After pregnancy the change in stroke volume is not reversed. Cardiac output rises from 4 to 7 litres in the 2nd trimester
Blood pressure also fluctuates. In the first trimester it falls. Initially this is due to decreased sensitivity to angiotensin and vasodilation provoked by increased blood volume. Later, however, it is caused by decreased resistance to the growing uteroplacental bed.
[edit] Respiratory changes
Decreased functional residual capacity is seen, typically falling from 1.7 to 1.35 litres, due to the compression of the diaphragm by the uterus. Tidal volume increases, from 0.45 to 0.65 litres, giving an increase in pulmonary ventilation. This is necessary to meet the increased oxygen requirement of the body, which reaches 50ml/min - 20ml of which goes to reproductive tissues.
Progesterone may act centrally on chemoreceptors to reset the set point to a lower partial pressure of carbon dioxide. This maintains an increased respiration rate even at a decreased level of carbon dioxide.
[edit] Metabolic changes
An increased requirement for nutrients is given by fetal growth and fat deposition. Changes are caused by steroid hormones, lactogen and cortisol.
Maternal insulin resistance can lead to gestational diabetes. Increase liver metabolism is also seen, with increased gluconeogenesis to increase maternal glucose levels.
[edit] Renal changes
Renal plasma flow increases, as does aldosterone and erthropoietin production as discussed. The tubular maximum for glucose is reduced, which may precipitate gestational diabetes.
[edit] Management
Prenatal medical care is of recognized value throughout the developed world. Periconceptional Folic acid supplementation is the only type of supplementation of proven efficacy.
[edit] Nutrition
Main article: Nutrition and pregnancy
A balanced, nutritious diet is an important aspect of a healthy pregnancy. Eating a healthy diet, balancing carbohydrates, fat, and proteins, and eating a variety of fruits and vegetables, usually ensures good nutrition. Those whose diets are affected by health issues, religious requirements, or ethical beliefs may choose to consult a health professional for specific advice.
Adequate periconceptional folic acid (also called folate or Vitamin B9) intake has been proven to limit fetal neural tube defects, preventing spina bifida, a very serious birth defect. The neural tube develops during the first 28 days of pregnancy, explaining the necessity to guarantee adequate periconceptional folate intake.[33][34] Folates (from folia, leaf) are abundant in spinach (fresh, frozen, or canned), and are also found in green vegetables, salads, citrus fruit and melon, chickpeas (i.e. in the form of hummus or falafel), and eggs. In the United States and Canada, most wheat products (flour, noodles) are fortified with folic acid.[35]
Several micronutrients are important for the health of the developing fetus, especially in areas of the world where insufficient nutrition is prevalent.[36] In developed areas, such as Western Europe and the United States, certain nutrients such as Vitamin D and calcium, required for bone development, may require supplementation.[37][38][39]
There is some evidence that long-chain omega-3 (n-3) fatty acids have an effect on the developing fetus, but further research is required.[40] At this time, supplementing the diet with foods rich in these fatty acids is not recommended, but is not harmful.[41]
Dangerous bacteria or parasites may contaminate foods, particularly listeria and toxoplasma, toxoplasmosis agent. Careful washing of fruits and raw vegetables may remove these pathogens, as may thoroughly cooking leftovers, meat, or processed meat. Soft cheeses may contain listeria; if milk is raw the risk may increase. Cat feces pose a particular risk of toxoplasmosis. Pregnant women are also more prone to catching salmonella infections from eggs and poultry, which should be thoroughly cooked. Practicing good hygiene in the kitchen can reduce these risks.[42]
[edit] Weight gain
Caloric intake must be increased, to ensure proper development of the fetus. The amount of weight gained during pregnancy varies among women. The National Health Service recommends that overall weight gain during the 9 month period for women who start pregnancy with normal weight be 10 to 12 kilograms (22–26 lb).[43] During pregnancy, insufficient weight gain can compromise the health of the fetus. Women with fears of weight gain or with eating disorders may choose to work with a health professional, to ensure that pregnancy does not trigger disordered eating. Likewise, excessive weight gain can pose risks to the woman and the fetus. Women who are prone to being overweight may choose to plan a healthy diet and exercise plan to help moderate the amount of weight gained.
[edit] Immunological tolerance
Main article: Pre-eclampsia
Research on the immunological basis for pre-eclampsia has indicated that continued exposure to a partner's semen has a strong protective effect against pre-eclampsia, largely due to the absorption of several immune modulating factors present in seminal fluid.[44] Studies also showed that long periods of sexual cohabitation with the same partner fathering a woman's child significantly decreased her chances of suffering pre-eclampsia.[45] Several other studies have since investigated the strongly decreased incidence of pre-eclampsia in women who had received blood transfusions from their partner, those with long, preceding histories of sex without barrier contraceptives, and in women who had been regularly performing oral sex,[46] with one study concluding that "induction of allogeneic tolerance to the paternal HLA molecules of the fetus may be crucial. Data collected strongly suggests that exposure, and especially oral exposure to soluble HLA from semen can lead to transplantation tolerance."[46]
Other studies have investigated the roles of semen in the female reproductive tracts of mice, showing that "insemination elicits inflammatory changes in female reproductive tissues,"[47] concluding that the changes "likely lead to immunological priming to paternal antigens or influence pregnancy outcomes." A similar series of studies confirmed the importance of immune modulation in female mice through the absorption of specific immune factors in semen, including TGF-Beta, lack of which is also being investigated as a cause of miscarriage in women and infertility in men.
According to the theory, pre-eclampsia is frequently caused by a failure of the mother's immune system to accept the fetus and placenta, which both contain "foreign" proteins from paternal genes. Regular exposure to the father's semen causes her immune system to develop tolerance to the paternal antigens, a process which is significantly supported by as many as 93 currently identified immune regulating factors in seminal fluid.[48][49] Having already noted the importance of a woman's immunological tolerance to her baby's paternal genes, several Dutch reproductive biologists decided to take their research a step further. Consistent with the fact that human immune systems tolerate things better when they enter the body via the mouth, the Dutch researchers conducted a series of studies that confirmed a surprisingly strong correlation between a diminished incidence of pre-eclampsia and a woman's practice of oral sex, and noted that the protective effects were strongest if she swallowed her partner's semen.[50] The researchers concluded that while any exposure to a partner's semen during sexual activity appears to decrease a woman's chances for the various immunological disorders that can occur during pregnancy, immunological tolerance could be most quickly established through oral introduction and gastrointestinal absorption of semen.[50] Recognizing that some of the studies potentially included the presence of confounding factors, such as the possibility that women who regularly perform oral sex and swallow semen might also engage in more frequent vaginal intercourse, the researchers also noted that, either way, the data still overwhelmingly supports the main theory behind all their studies--that repeated exposure to semen establishes the maternal immunological tolerance necessary for a safe and successful pregnancy.
[edit] Sexuality during pregnancy
Most pregnant women can enjoy sexual intercourse throughout gravidity. Most research suggests that, during pregnancy, both sexual desire and frequency of sexual relations decrease.[51][52] In context of this overall decrease in desire, some studies indicate a second-trimester increase, preceding a decrease.[53] However, these decreases are not universal: a significant number of women report greater sexual satisfaction throughout their pregnancies.[54]
Sex during pregnancy is a low-risk behaviour except when the physician advises that sexual intercourse be avoided, which may, in some pregnancies, lead to serious pregnancy complications or health issues such as a high-risk for premature labour or a ruptured uterus. Such a decision may be based upon a history of difficulties in a previous childbirth.
Some psychological research studies in the 1980s and '90s contend that it is useful for pregnant women to continue to have sexual activity, specifically noting that overall sexual satisfaction was correlated with feeling happy about being pregnant, feeling more attractive in late pregnancy than before pregnancy and experiencing orgasm.[53] Sexual activity has also been suggested as a way to prepare for induced labour; some believe the natural prostaglandin content of seminal liquid can favour the maturation process of the cervix making it more flexible, allowing for easier and faster dilation and effacement of the cervix. However, the efficacy of using sexual intercourse as an induction agent "remains uncertain".[55]
During pregnancy, the baby is protected from penetrative thrusting by the amniotic fluid in the womb and by the woman's abdomen.[56]
[edit] Abortion
Main article: Abortion
An abortion is the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death. This can occur spontaneously or accidentally as with a miscarriage, or be artificially induced by medical, surgical or other means.
[edit] Progression
[edit] Complaints
See also: Complications of pregnancy
The following are complaints that may occur during pregnancy:
Back pain. A particularly common complaint in the third trimester when the patient's center of gravity has shifted.
Constipation. A complaint that is caused by decreased bowel motility secondary to elevated progesterone (normal in pregnancy), which can lead to greater absorption of water.
Braxton Hicks contractions. Occasional, irregular, and often painless contractions that occur several times per day.
Edema (swelling). Common complaint in advancing pregnancy. Caused by compression of the inferior vena cava (IVC) and pelvic veins by the uterus leads to increased hydrostatic pressure in lower extremities.
Regurgitation, heartburn, and nausea. Common complaints that may be caused by Gastroesophageal Reflux Disease (GERD); this is determined by relaxation of the lower esophageal sphincter (LES) and increased transit time in the stomach (normal in pregnancy)
Haemorrhoids. Complaint that is often noted in advancing pregnancy. Caused by increased venous stasis and IVC compression leading to congestion in venous system, along with increased abdominal pressure secondary to the pregnant space-occupying uterus and constipation.
Pelvic girdle pain. A common complaint is pain, instability or dysfunction of the symphysis pubis and/or sacroiliac joints resulting from either excess strain or injury (such as Diastasis symphysis pubis) during the course of the pregnancy or birthing process.
Increased urinary frequency. A common complaint referred by the gravida, caused by increased intravascular volume, elevated GFR (glomerular filtration rate), and compression of the bladder by the expanding uterus.
Varicose veins. Common complaint caused by relaxation of the venous smooth muscle and increased intravascular pressure.
[edit] Childbirth
Main article: Childbirth
Childbirth is the process whereby an infant is born. It is considered by many to be the beginning of a person's life, and age is defined relative to this event in most cultures.
A woman is considered to be in labour when she begins experiencing regular uterine contractions, accompanied by changes of her cervix — primarily effacement and dilation. While childbirth is widely experienced as painful, some women do report painless labours, while others find that concentrating on the birth helps to quicken labour and lessen the sensations. Most births are successful vaginal births, but sometimes complications arise and a woman may undergo a caesarean section.
During the time immediately after birth, both the mother and the baby are hormonally cued to bond, the mother through the release of oxytocin, a hormone also released during breastfeeding.
[edit] Postnatal period
Main article: Postnatal
[edit] Context
There are fine distinctions between the concepts of fertilization and the actual state of pregnancy, which starts with implantation. In a normal pregnancy, the fertilization of the egg usually will have occurred in the Fallopian tubes or in the uterus. (Often, an egg may become fertilized yet fail to become implanted in the uterus.) If the pregnancy is the result of in-vitro fertilization, the fertilization will have occurred in a Petri dish, after which pregnancy begins when one or more zygotes implant after being transferred by a physician into the woman's uterus.
In the context of political debates regarding a proper definition of life, the terminology of pregnancy can be confusing. The medically and politically neutral term which remains is simply "pregnancy," though this can be problematic as it only refers indirectly to the embryo or fetus. De Crespigny observes that doctors' language has a powerful influence over the way patients think, and thus proposes that the best interests of patients are served by using language that both supports patient autonomy and is neutral.[57]
wikipedia.org/wiki/pregnancy
Childbirth usually occurs about 38 weeks after fertilization (conception), i.e., approximately 40 weeks from the the last normal menstrual period (LNMP) in humans. The date of delivery is considered normal medically if it falls within two weeks of the calculated date. The calculation of this date involves the assumption of a regular 28-day period. Thus, pregnancy lasts almost nine months, although the exact definition of the English word “pregnancy” is a subject of controversy.
Terminology
One scientific term for the state of pregnancy is gravid, and a pregnant female is sometimes referred to as a gravida.[1] Both words are rarely used in common speech. Similarly, the term "parity" (abbreviated as "para") is used for the number of previous successful live births. Medically, a woman who is not currently pregnant or who has never been pregnant is referred to as a "nulligravida", and in subsequent pregnancies as "multigravida" or "multiparous".[2] Hence during a second pregnancy a woman would be described as "gravida 2, para 1" and upon delivery as "gravida 2, para 2". Incomplete pregnancies of abortions, miscarriages or stillbirths account for parity values being less than the gravida number, whereas a multiple birth will increase the parity value. Women who have never carried a pregnancy achieving more than 20 weeks of gestation age are referred to as "nulliparous".[3]
The term embryo is used to describe the developing offspring during the first eight weeks following conception, and the term fetus is used from about two months of development until birth.[4][5]
In many societies' medical and legal definitions, human pregnancy is somewhat arbitrarily divided into three trimester periods, as a means to simplify reference to the different stages of prenatal development. The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus). During the second trimester, the development of the fetus can be more easily monitored and diagnosed. The beginning of the third trimester often approximates the point of viability, or the ability of the fetus to survive, with or without medical help, outside of the uterus.[6]
[edit] Characteristics
Pregnancy occurs as the result of the female gamete or oocyte (egg) being penetrated by the male gamete spermatozoon in a process referred to, in medicine, as "fertilization", or more commonly known as "conception". The fusion of male and female gametes usually occurs through the act of sexual intercourse. However, the advent of artificial insemination has also made achieving pregnancy possible in such cases where sexual intercourse is not potentially fertile (through choice or male/female infertility).
A number of medical signs are associated with pregnancy.[7][8] These signs typically appear, if at all, within the first few weeks after conception. Although not all of these signs are universally present, nor are all of them diagnostic by themselves, taken together they make a presumptive diagnosis of pregnancy. These signs include the presence of human chorionic gonadotropin (hCG) in the blood and urine, missed menstrual period, implantation bleeding that occurs at implantation of the embryo in the uterus during the third or fourth week after last menstrual period, increased basal body temperature sustained for over two weeks after ovulation, Chadwick's sign (darkening of the cervix, vagina, and vulva), Goodell's sign (softening of the vaginal portion of the cervix), Hegar's sign (softening of the uterus isthmus), and pigmentation of linea alba - Linea nigra, (darkening of the skin in a midline of the abdomen, caused by hyperpigmentation resulting from hormonal changes; it usually appears around the middle of pregnancy).[7][8]
[edit] Duration
The expected date of delivery (EDD) is 40 weeks counting from the last menstrual period (LMP) and usually lasts between 37 and 42 weeks,[9] The actual pregnancy duration is typically 38 weeks after conception. Though pregnancy begins at conception, it is more convenient to date from the first day of a woman's last menstrual period, or from the date of conception if known. Starting from one of these dates, the expected date of delivery can be calculated. 40 weeks is nine months and six days, which forms the basis of Naegele's rule for estimating date of delivery. More accurate algorithms which take into account other variables, such as whether this is the first or subsequent child (i.e. mother is a primip or a multip, respectively), ethnicity, parental age, length of menstrual cycle and menstrual regularity form the basis for more sophisticated online calculation methods.
Pregnancy is considered 'at term' when gestation attains 37 complete weeks but is less than 42 (between 259 and 294 days since LMP). Events before completion of 37 weeks (259 days) are considered pre-term; from week 42 (294 days) events are considered post-term.[10] When a pregnancy exceeds 42 weeks (294 days), the risk of complications for mother and fetus increases significantly.[9][11] As such, obstetricians usually prefer to induce labour, in an uncomplicated pregnancy, at some stage between 41 and 42 weeks.[12][13]
Recent medical literature prefers the terminology pre-term and post-term to premature and post-mature. Pre-term and post-term are unambiguously defined as above, whereas premature and postmature have historical meaning and relate more to the infant's size and state of development rather than to the stage of pregnancy.[14][15]
Fewer than 5% of births occur on the due date; 50% of births are within a week of the due date, and almost 90% within two weeks.[16] It is much more useful to consider therefore a range of due dates, rather than one specific day, with some online due date calculators providing this information.
Accurate dating of pregnancy is important, because it is used in calculating the results of various prenatal tests (for example, in the triple test). A decision may be made to induce labour if a fetus is perceived to be overdue. Furthermore, if a difference of predicted due date is highlighted between dates based on LMP and ultrasound dating, with the latter being later, this might signify slowed fetal growth and therefore the need for closer review.
[edit] Diagnosis
Main article: Obstetrics
The beginning of pregnancy may be detected in a number of ways, including various pregnancy tests which detect hormones generated by the newly-formed placenta. Clinical blood and urine tests can detect pregnancy soon after implantation, which is as early as 6-8 days after fertilization. Home pregnancy tests are personal urine tests, which normally cannot detect a pregnancy until at least 12-15 days after fertilization. Both clinical and home tests can only detect the state of pregnancy, and cannot detect the age of the embryo.
In the post-implantation phase, the blastocyst secretes a hormone named human chorionic gonadotropin which in turn, stimulates the corpus luteum in the woman's ovary to continue producing progesterone. This acts to maintain the lining of the uterus so that the embryo will continue to be nourished. The glands in the lining of the uterus will swell in response to the blastocyst, and capillaries will be stimulated to grow in that region. This allows the blastocyst to receive vital nutrients from the woman.
Despite all the signs, some women will not realize they are pregnant until they are quite far along in their pregnancy, sometimes not until they are nearing the time of their birth. This can be caused by many factors, namely irregular periods (quite common in teenage pregnancies), or heavily over weight or obese women who do not notice their weight gain. Teenagers in developing countries who have no sexual education what so ever, won't even know they are pregnant until the day they give birth, despite their large abdomen growth[citation needed].
An early sonograph can determine the age of the pregnancy fairly accurately. In practice, doctors typically express the age of a pregnancy (i.e. an "age" for an embryo) in terms of "menstrual date" based on the first day of a woman's last menstrual period, as the woman reports it. Unless a woman's recent sexual activity has been limited, or she has been charting her cycles, or the conception is as the result of some types of fertility treatment (such as IUI or IVF) the exact date of fertilization is unknown. Absent symptoms such as morning sickness, often the only visible sign of a pregnancy is an interruption of her normal monthly menstruation cycle, (i.e. a "late period"). Hence, the "menstrual date" is simply a common educated estimate for the age of a fetus, which is an average of two weeks later than the first day of the woman's last menstrual period. The term "conception date" may sometimes be used when that date is more certain, though even medical professionals can be imprecise with their use of the two distinct terms. The due date can be calculated by using Naegele's rule. The expected date of delivery may also be calculated from sonogram measurement of the fetus. This method is slightly more accurate than methods based on LMP.[17] The beginning of labour, which is variously called confinement or childbed, begins on the day predicted by LMP 3.6% of the time and on the day predicted by sonography 4.3% of the time.[18]
Diagnostic criteria are: Women who have menstrual cycles and are sexually active, a period delayed by a few days or weeks is suggestive of pregnancy; elevated B-hcG to around 100,000 mIU/mL by 10 weeks of gestation.[1]
[edit] Physiology
The term trimester redirects here. For the term trimester used in academic settings, see Academic term
Pregnancy is typically broken into three periods, or trimesters, each of about three months. While there are no hard and fast rules, these distinctions are useful in describing the changes that take place over time.
[edit] First trimester
Comparison of growth of the abdomen between 26 weeks and 40 weeks gestation.
Traditionally, doctors have measured pregnancy from a number of convenient points, including the day of last menstruation, ovulation, fertilization, implantation and chemical detection. In medicine, pregnancy is often defined as beginning when the developing embryo becomes implanted into the endometrial lining of a woman's uterus. In some cases where complications may have arisen, the fertilized egg might implant itself in the fallopian tubes or the cervix, causing an ectopic pregnancy. Most pregnant women do not have any specific signs or symptoms of implantation, although it is not uncommon to experience light bleeding at implantation. Some women will also experience cramping during their first trimester. This is usually of no concern unless there is spotting or bleeding as well. The outer layers of the embryo grow and form a placenta, for the purpose of receiving essential nutrients through the uterine wall, or endometrium. The umbilical cord in a newborn child consists of the remnants of the connection to the placenta. The developing embryo undergoes tremendous growth and changes during the process of foetal development.
Morning sickness can occur in about seventy percent of all pregnant women and typically improves after the first trimester.[19] Most miscarriages occur during this period.
A pregnant woman at 26 weeks
[edit] Second trimester
Months 4 through 6 of the pregnancy are called the second trimester. Most women feel more energized in this period, and begin to seriously put on weight as the symptoms of morning sickness subside and eventually fade away. Although the fetus begins moving and takes a recognizable human shape during the first trimester, it is not until the second trimester that movement of the fetus, often referred to as "quickening", can be felt. This typically happens in the fourth month more specifically in the 20 to 21 week or by the 18th week if you've been pregnant before. However, it is not uncommon for some women to not feel the baby move until much later. The placenta is now fully functioning and the fetus is making insulin and urinating. The reproductive organs can be recognized, and can distinguish the fetus as male or female.
[edit] Third trimester
Final weight gain takes place, which is the most weight gain throughout the pregnancy. The fetus will be growing the most rapidly during this stage, gaining up to 28g per day. The woman's belly will transform in shape as the belly drops due the the fetus turning in a downward position ready for birth. During the second trimester, the woman's belly would have been very upright, whereas in the third trimester it will drop down quite low, the woman will be able to lift her belly up and down. The fetus begins to move regularly, and is felt by the woman. Fetal movement can become quite strong and be disruptive to the woman. The woman's navel will sometimes become convex, "popping" out, due to her expanding abdomen. This period of her pregnancy can be uncomfortable, causing symptoms like weak bladder control and back-ache. Movement of the fetus becomes stronger and more frequent and via improved brain, eye, and muscle function the fetus is prepared for ex utero viability. The woman can feel the fetus "rolling" and it may cause pain or discomfort when it is near the woman's ribs and spine.
It is during this time that a baby born prematurely may survive. The use of modern medical intensive care technology has greatly increased the probability of premature babies surviving, and has pushed back the boundary of viability to much earlier dates than would be possible without assistance.[20] In spite of these developments, premature birth remains a major threat to the fetus, and may result in ill-health in later life, even if the baby survives.
[edit] Prenatal development and sonograph images
See also: Prenatal development
Prenatal development is divided into two primary biological stages. The first is the embryonic stage, which lasts for about two months. At this point, the fetal stage begins. At the beginning of the foetal stage, the risk of miscarriage decreases sharply,[21] all major structures including hands, feet, head, brain, and other organs are present, and they continue to grow and develop. When the fetal stage commences, a fetus is typically about 30 mm (1.2 inches) in length, and the heart can be seen beating via sonograph; the fetus bends the head, and also makes general movements and startles that involve the whole body.[22] Some fingerprint formation occurs from the beginning of the fetal stage.[23]
Electrical brain activity is first detected between the 5th and 6th week of gestation, though this is still considered primitive neural activity rather than the beginning of conscious thought, something that develops much later in fetation. Synapses begin forming at 17 weeks, and at about week 28 begin multiply at a rapid pace which continues until 3-4 months after birth. It isn't until week 23 that the fetus can survive, albeit with major medical support, outside of the womb. It is not until then that the fetus possesses a sustainable human brain. [24]
Embryo at 6 weeks after fertilization[25]
Fetus at 8 weeks after fertilization[26]
Fetus at 18 weeks after fertilization[27]
Fetus at 38 weeks after fertilization[28]
Relative size in 1st month (simplified illustration)
Relative size in 3rd month (simplified illustration)
Relative size in 5th month (simplified illustration)
Relative size in 9th month (simplified illustration)
One way to observe prenatal development is via ultrasound images. Modern 3D ultrasound images provide greater detail for prenatal diagnosis than the older 2D ultrasound technology.[29] Whilst 3D is popular with parents desiring a prenatal photograph as a keepsake,[30] both 2D and 3D are discouraged by the FDA for non-medical use,[31] but there are no definitive studies linking ultrasound to any adverse medical effects.[32] The following 3D ultrasound images were taken at different stages of pregnancy:
3-inch fetus (about 14 weeks gestational age)
Fetus at 17 weeks
Fetus at 20 weeks
[edit] Physiological changes in pregnancy
The body must change its physiological and homeostatic mechanisms in pregnancy to ensure the fetus is provided for. Increases in blood sugar, breathing and cardiac output are all required.
[edit] Hormonal changes
Levels of progesterone and oestrogens rise continually throughout pregnancy, suppressing the hypothalamic axis and subsequently the menstrual cycle. The mother and the placenta also produces many hormones.
Prolactin levels increase due to maternal Pituitary gland enlargement by 50%. This mediates a change in the structure of the Mammary gland from ductal to lobular-alveolar. Parathyroid hormone is increased due to increases of calcium uptake in the gut and reabsorption by the kidney. Adrenal hormones such as cortisol and aldosterone also increase.
Placental lactogen is produced by the placenta and stimulates lipolysis and fatty acid metabolism by the mother, conserving blood glucose for use by the fetus. It also decreases maternal tissue sensitivity to insulin, resulting in gestational diabetes.
[edit] Musculoskeletal changes
The body's posture changes as the pregnancy progresses. The pelvis tilts and the back arches to help keep balance. Poor posture occurs naturally from the stretching of the woman's abdominal muscles as the baby grows. These muscles are less able to contract and keep the lower back in proper alignment. The pregnant woman has a different pattern of gait. The step lengthens as the pregnancy progresses, due to weight gain and changes in posture. On average, a woman's foot can grow by a half size or more during pregnancy. In addition, the increased body weight of pregnancy, fluid retention, and weight gain lowers the arches of the foot, further adding to the foot's length and width. The influences of increased hormones such as estrogen and relaxin initiate the remodeling of soft tissues, cartilage and ligaments. Certain skeletal joints such as the symphysis pubis and sacroiliac widen or have increased laxity.
[edit] Physical changes
Weight is gained during pregnancy due to increased appetite, fat deposition, and growth of the reproductive organs and fetus, as well as increased blood volume and water retention. Anywhere from 5 to over 100 pounds can be gained during pregnancy. In America, the doctor-recommended weight gain range is 25-35 pounds, less if the woman is overweight, more (up to 40) if the woman is underweight.
[edit] Cardiovascular changes
Blood volume increases by 40% in the first two trimesters. This is due to an increase in plasma volume through increased aldosterone. Progesterone may also interact with the aldosterone receptor, thus leading to increased levels. Red blood cell numbers increase due to increased erythropoietin levels.
Cardiac function is also modified, with increase heart rate and increased stroke volume. A decrease in vagal tone and increase in sympathetic tone is the cause. Blood volume increases act to increase stroke volume of the heart via Starling's law. After pregnancy the change in stroke volume is not reversed. Cardiac output rises from 4 to 7 litres in the 2nd trimester
Blood pressure also fluctuates. In the first trimester it falls. Initially this is due to decreased sensitivity to angiotensin and vasodilation provoked by increased blood volume. Later, however, it is caused by decreased resistance to the growing uteroplacental bed.
[edit] Respiratory changes
Decreased functional residual capacity is seen, typically falling from 1.7 to 1.35 litres, due to the compression of the diaphragm by the uterus. Tidal volume increases, from 0.45 to 0.65 litres, giving an increase in pulmonary ventilation. This is necessary to meet the increased oxygen requirement of the body, which reaches 50ml/min - 20ml of which goes to reproductive tissues.
Progesterone may act centrally on chemoreceptors to reset the set point to a lower partial pressure of carbon dioxide. This maintains an increased respiration rate even at a decreased level of carbon dioxide.
[edit] Metabolic changes
An increased requirement for nutrients is given by fetal growth and fat deposition. Changes are caused by steroid hormones, lactogen and cortisol.
Maternal insulin resistance can lead to gestational diabetes. Increase liver metabolism is also seen, with increased gluconeogenesis to increase maternal glucose levels.
[edit] Renal changes
Renal plasma flow increases, as does aldosterone and erthropoietin production as discussed. The tubular maximum for glucose is reduced, which may precipitate gestational diabetes.
[edit] Management
Prenatal medical care is of recognized value throughout the developed world. Periconceptional Folic acid supplementation is the only type of supplementation of proven efficacy.
[edit] Nutrition
Main article: Nutrition and pregnancy
A balanced, nutritious diet is an important aspect of a healthy pregnancy. Eating a healthy diet, balancing carbohydrates, fat, and proteins, and eating a variety of fruits and vegetables, usually ensures good nutrition. Those whose diets are affected by health issues, religious requirements, or ethical beliefs may choose to consult a health professional for specific advice.
Adequate periconceptional folic acid (also called folate or Vitamin B9) intake has been proven to limit fetal neural tube defects, preventing spina bifida, a very serious birth defect. The neural tube develops during the first 28 days of pregnancy, explaining the necessity to guarantee adequate periconceptional folate intake.[33][34] Folates (from folia, leaf) are abundant in spinach (fresh, frozen, or canned), and are also found in green vegetables, salads, citrus fruit and melon, chickpeas (i.e. in the form of hummus or falafel), and eggs. In the United States and Canada, most wheat products (flour, noodles) are fortified with folic acid.[35]
Several micronutrients are important for the health of the developing fetus, especially in areas of the world where insufficient nutrition is prevalent.[36] In developed areas, such as Western Europe and the United States, certain nutrients such as Vitamin D and calcium, required for bone development, may require supplementation.[37][38][39]
There is some evidence that long-chain omega-3 (n-3) fatty acids have an effect on the developing fetus, but further research is required.[40] At this time, supplementing the diet with foods rich in these fatty acids is not recommended, but is not harmful.[41]
Dangerous bacteria or parasites may contaminate foods, particularly listeria and toxoplasma, toxoplasmosis agent. Careful washing of fruits and raw vegetables may remove these pathogens, as may thoroughly cooking leftovers, meat, or processed meat. Soft cheeses may contain listeria; if milk is raw the risk may increase. Cat feces pose a particular risk of toxoplasmosis. Pregnant women are also more prone to catching salmonella infections from eggs and poultry, which should be thoroughly cooked. Practicing good hygiene in the kitchen can reduce these risks.[42]
[edit] Weight gain
Caloric intake must be increased, to ensure proper development of the fetus. The amount of weight gained during pregnancy varies among women. The National Health Service recommends that overall weight gain during the 9 month period for women who start pregnancy with normal weight be 10 to 12 kilograms (22–26 lb).[43] During pregnancy, insufficient weight gain can compromise the health of the fetus. Women with fears of weight gain or with eating disorders may choose to work with a health professional, to ensure that pregnancy does not trigger disordered eating. Likewise, excessive weight gain can pose risks to the woman and the fetus. Women who are prone to being overweight may choose to plan a healthy diet and exercise plan to help moderate the amount of weight gained.
[edit] Immunological tolerance
Main article: Pre-eclampsia
Research on the immunological basis for pre-eclampsia has indicated that continued exposure to a partner's semen has a strong protective effect against pre-eclampsia, largely due to the absorption of several immune modulating factors present in seminal fluid.[44] Studies also showed that long periods of sexual cohabitation with the same partner fathering a woman's child significantly decreased her chances of suffering pre-eclampsia.[45] Several other studies have since investigated the strongly decreased incidence of pre-eclampsia in women who had received blood transfusions from their partner, those with long, preceding histories of sex without barrier contraceptives, and in women who had been regularly performing oral sex,[46] with one study concluding that "induction of allogeneic tolerance to the paternal HLA molecules of the fetus may be crucial. Data collected strongly suggests that exposure, and especially oral exposure to soluble HLA from semen can lead to transplantation tolerance."[46]
Other studies have investigated the roles of semen in the female reproductive tracts of mice, showing that "insemination elicits inflammatory changes in female reproductive tissues,"[47] concluding that the changes "likely lead to immunological priming to paternal antigens or influence pregnancy outcomes." A similar series of studies confirmed the importance of immune modulation in female mice through the absorption of specific immune factors in semen, including TGF-Beta, lack of which is also being investigated as a cause of miscarriage in women and infertility in men.
According to the theory, pre-eclampsia is frequently caused by a failure of the mother's immune system to accept the fetus and placenta, which both contain "foreign" proteins from paternal genes. Regular exposure to the father's semen causes her immune system to develop tolerance to the paternal antigens, a process which is significantly supported by as many as 93 currently identified immune regulating factors in seminal fluid.[48][49] Having already noted the importance of a woman's immunological tolerance to her baby's paternal genes, several Dutch reproductive biologists decided to take their research a step further. Consistent with the fact that human immune systems tolerate things better when they enter the body via the mouth, the Dutch researchers conducted a series of studies that confirmed a surprisingly strong correlation between a diminished incidence of pre-eclampsia and a woman's practice of oral sex, and noted that the protective effects were strongest if she swallowed her partner's semen.[50] The researchers concluded that while any exposure to a partner's semen during sexual activity appears to decrease a woman's chances for the various immunological disorders that can occur during pregnancy, immunological tolerance could be most quickly established through oral introduction and gastrointestinal absorption of semen.[50] Recognizing that some of the studies potentially included the presence of confounding factors, such as the possibility that women who regularly perform oral sex and swallow semen might also engage in more frequent vaginal intercourse, the researchers also noted that, either way, the data still overwhelmingly supports the main theory behind all their studies--that repeated exposure to semen establishes the maternal immunological tolerance necessary for a safe and successful pregnancy.
[edit] Sexuality during pregnancy
Most pregnant women can enjoy sexual intercourse throughout gravidity. Most research suggests that, during pregnancy, both sexual desire and frequency of sexual relations decrease.[51][52] In context of this overall decrease in desire, some studies indicate a second-trimester increase, preceding a decrease.[53] However, these decreases are not universal: a significant number of women report greater sexual satisfaction throughout their pregnancies.[54]
Sex during pregnancy is a low-risk behaviour except when the physician advises that sexual intercourse be avoided, which may, in some pregnancies, lead to serious pregnancy complications or health issues such as a high-risk for premature labour or a ruptured uterus. Such a decision may be based upon a history of difficulties in a previous childbirth.
Some psychological research studies in the 1980s and '90s contend that it is useful for pregnant women to continue to have sexual activity, specifically noting that overall sexual satisfaction was correlated with feeling happy about being pregnant, feeling more attractive in late pregnancy than before pregnancy and experiencing orgasm.[53] Sexual activity has also been suggested as a way to prepare for induced labour; some believe the natural prostaglandin content of seminal liquid can favour the maturation process of the cervix making it more flexible, allowing for easier and faster dilation and effacement of the cervix. However, the efficacy of using sexual intercourse as an induction agent "remains uncertain".[55]
During pregnancy, the baby is protected from penetrative thrusting by the amniotic fluid in the womb and by the woman's abdomen.[56]
[edit] Abortion
Main article: Abortion
An abortion is the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death. This can occur spontaneously or accidentally as with a miscarriage, or be artificially induced by medical, surgical or other means.
[edit] Progression
[edit] Complaints
See also: Complications of pregnancy
The following are complaints that may occur during pregnancy:
Back pain. A particularly common complaint in the third trimester when the patient's center of gravity has shifted.
Constipation. A complaint that is caused by decreased bowel motility secondary to elevated progesterone (normal in pregnancy), which can lead to greater absorption of water.
Braxton Hicks contractions. Occasional, irregular, and often painless contractions that occur several times per day.
Edema (swelling). Common complaint in advancing pregnancy. Caused by compression of the inferior vena cava (IVC) and pelvic veins by the uterus leads to increased hydrostatic pressure in lower extremities.
Regurgitation, heartburn, and nausea. Common complaints that may be caused by Gastroesophageal Reflux Disease (GERD); this is determined by relaxation of the lower esophageal sphincter (LES) and increased transit time in the stomach (normal in pregnancy)
Haemorrhoids. Complaint that is often noted in advancing pregnancy. Caused by increased venous stasis and IVC compression leading to congestion in venous system, along with increased abdominal pressure secondary to the pregnant space-occupying uterus and constipation.
Pelvic girdle pain. A common complaint is pain, instability or dysfunction of the symphysis pubis and/or sacroiliac joints resulting from either excess strain or injury (such as Diastasis symphysis pubis) during the course of the pregnancy or birthing process.
Increased urinary frequency. A common complaint referred by the gravida, caused by increased intravascular volume, elevated GFR (glomerular filtration rate), and compression of the bladder by the expanding uterus.
Varicose veins. Common complaint caused by relaxation of the venous smooth muscle and increased intravascular pressure.
[edit] Childbirth
Main article: Childbirth
Childbirth is the process whereby an infant is born. It is considered by many to be the beginning of a person's life, and age is defined relative to this event in most cultures.
A woman is considered to be in labour when she begins experiencing regular uterine contractions, accompanied by changes of her cervix — primarily effacement and dilation. While childbirth is widely experienced as painful, some women do report painless labours, while others find that concentrating on the birth helps to quicken labour and lessen the sensations. Most births are successful vaginal births, but sometimes complications arise and a woman may undergo a caesarean section.
During the time immediately after birth, both the mother and the baby are hormonally cued to bond, the mother through the release of oxytocin, a hormone also released during breastfeeding.
[edit] Postnatal period
Main article: Postnatal
[edit] Context
There are fine distinctions between the concepts of fertilization and the actual state of pregnancy, which starts with implantation. In a normal pregnancy, the fertilization of the egg usually will have occurred in the Fallopian tubes or in the uterus. (Often, an egg may become fertilized yet fail to become implanted in the uterus.) If the pregnancy is the result of in-vitro fertilization, the fertilization will have occurred in a Petri dish, after which pregnancy begins when one or more zygotes implant after being transferred by a physician into the woman's uterus.
In the context of political debates regarding a proper definition of life, the terminology of pregnancy can be confusing. The medically and politically neutral term which remains is simply "pregnancy," though this can be problematic as it only refers indirectly to the embryo or fetus. De Crespigny observes that doctors' language has a powerful influence over the way patients think, and thus proposes that the best interests of patients are served by using language that both supports patient autonomy and is neutral.[57]
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