As pregnancy advances, more and more demands are made upon the mother’s reserves of iron. During the last twelve weeks a considerable amount of iron is transferred from the mother to the baby. It is essential that these depleted stores be made up to normal.

Even during normal non-pregnant life, women run a greater risk of having reduced stores of iron. Menstruation each month reduces the supply. Although a certain amount of this is made up during the subsequent month, it is very common for the level to be less than normal even early in pregnancy.

For this reason, the doctor usually orders a haemoglobin examination at an early date in pregnancy. The haemoglobin is the red material in the red blood cells, and iron is used in its manufacture. Unless this is present in normal amounts, the body (including the foetus) is unable to gain sufficient supplies of oxygen, and difficulties may be encountered.

With more severe forms of anaemia (as this condition is called), symptoms will appear. Fatigue ‘more than would normally be expected), shortness of breath, a pale complexion and swelling of the tissues (referred to as oedema) may occur.

These are very important symptoms, indicating an immediate need for treatment.

However, the doctor usually has taken the matter in hand well before these symptoms are likely to put in appearance.

Treatment is generally very successful. It is usually given in a form that can be taken orally. Many different forms are available. Some patients are sensitive to some iron salts, and changes are necessary. But usually a certain brand is available that is suitable and can be tolerated satisfactorily.

Sometimes another chemical called folic acid is in short supply, and this may be given in conjunction. It is also needed to keep the blood in good order.

By sticking to a sensible iron-rich eating routine, the risks of anaemia are far less.

An iron-rich diet is usually a vitamin-rich diet as well. If the mother-to-be acquires this naturally, the need for medication is often reduced.

The original blood test carried out at the first consultation is often repeated at the thirty-second and thirty-sixth weeks of pregnancy, for these are critical times when iron utilization is high. Any deficiencies must be brought back to normal as promptly as possible.

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Women’s Health

Infections which occur in the bladder, and which spread into the narrow tubes leading to the kidney (called the ureters) are common during pregnancy, particularly after the twentieth week.

Because of increased amounts of hormone in the bloodstream, the ureters tend to dilate, and this may encourage germs to travel from the bladder into the cavities of the kidney.

Due to changes occurring in the pelvis, complete emptying of the bladder is often difficult. Small amounts of urine are left, forming a reservoir for proliferating germs. Here they multiply rapidly. Frequently, no symptoms occur, and the infection simply smoulders on silently.

But when the germs commence moving into the ureters and on into the kidneys, symptoms can suddenly flare. Elevated temperatures, chills, fevers, aches in the lower back region, aches and pains all over, frequency of urination, the desire to empty the bladder a short time after this has already been done, with little satisfaction, all become commonplace symptoms. Vomiting and a high pulse-rate might also occur.

These demands prompt medical attention. The doctor will probably order a laboratory test on the urine. In this manner the organism producing the infection can be isolated, and the antibiotic to which it is most responsive determined. Treatment is usually commenced at once. Bed rest and lots of fluid are essential.

Women’s Health

Here are some of the more likely reasons as to why a legal termination may be considered by the gynaecologist:

• Severe heart disease. If pregnancy is complicated by severe forms of heart disease, and cardiac surgery to the mother is impractical, then termination may be the only way out for her, to save her own life.

• Chest disease. T.B. is rare today, but occasionally this may be a reason, particularly if the patient is unable to tolerate her medication.

• Kidney disease. If the kidneys are severely diseased, it may be imperative to terminate the pregnancy.

• Psychiatric conditions. Certain cases benefit from a termination. (Indeed, this is the aspect most openly abused. However, the doctor should genuinely assess each case that presents, and make a decision after carefully examining the full case-history.)

• Cancer. Malignant disease in young women is often rapidly growing, and may prove fatal in the event of pregnancy. Such a patient would be a certain candidate for termination.

Women’s Health

Technically, several different kinds of abortions are recognized by the doctor. But from a practical point of view, it doesn’t matter too much about the technical features. What matters most is that a sudden halt occurs in the normal progression of the pregnancy. Often this requires prompt medical attention to avert serious consequences.

The first indication that all is not well is that vaginal bleeding commences. This may be any time during the first twenty-eight weeks of pregnancy, but more commonly in the six- to ten-week period.

The bleeding might commence as brown spotting which may gradually or rapidly increase in volume and nature. It may become red, and be associated with cramp-like pains in the lower abdominal regions. The amount may be small or it may be profuse.

If it starts off red then gradually reduces and becomes brown, the chances are fairly high that it will settle down. If the brown discharge continues, the risk of abortion increases. If brownish discharge increases and becomes bright red, then there is a far greater risk of the embryo aborting.

Many cases settle down, and proceed thereafter to term. But many gradually continue, and finally abort completely. The patient may suddenly feel as though she “is passing something” (a common expression). This may be accompanied by several severe cramp-like pains, more bright-red bleeding, then a reduction in both. Sometimes the products of conception are self-delivered at the lower end of the vagina. At other times, they become stuck part way, and the bleeding and discomfort continue.

Whatever happens, bleeding with or without pain is certainly an urgent recommendation for prompt medical assistance. A proper examination will enable the doctor to advise whether simple measures are likely to allow the impending abortion to settle down, or whether surgical intervention is necessary to avoid further risk and blood loss to the patient.

In the latter instance, of course, prompt hospital admission is arranged, and the correct procedures undertaken forthwith, before further haemorrhaging takes place. Many women are upset when an abortion prematurely ends a pregnancy they had wanted. However, most doctors take the sensible view and endeavor to explain the position to their patients. This is usually nature’s way out of a situation that could produce later problems to the parents.

When this is pointed out, a different complexion is usually given to the whole picture, and most patients are then quite satisfied and indeed glad that it ended in this way, rather than face possible difficulties in the future.

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Women’s Health

Normally, the average pregnancy consists of one single foetus. But about once in ninety cases, twins occur.

The rate at which triplets occur is 1 in 90 x 90 pregnancies, and quadruplets 1 in 90 x 90 x 90. This is the rate in Western lands. It is more common in Africa and Asia where a larger hereditary factor apparently plays a part.

There are two types of twins: “Binovular” twins occur when two separate eggs (or ova) are released and fertilized at the same time. Each foetus is a separate entity and is quite distinct from its fellow. “Uni-ovular” twins come from one single egg which has prematurely divided into two separate entities.

Twins are often diagnosed before their birth, but about 20 per cent are not recognized until the moment of delivery. Features which make a patient and the doctor suspect multiple births are mainly the size of the abdomen and womb which are larger than would be expected at any given time.

Sometimes two heads may be felt through the abdominal wall by the doctor’s examining hands. Frequently, the only sure way is by X-ray or ultra-sound examination of the womb. Two separate heads and bodies can be clearly detected in this manner.

Generally, multiple births proceed to term normally. But there is an increased risk of certain complications taking place, so the mother may be requested to attend more frequently for her prenatal examinations. Some cases end in premature labour.

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Women’s Health

During pregnancy there is a natural increase in the normal vaginal secretions. This is not serious, and should cause no worry.

However, there are two organisms which have a predilection for reproducing in the vagina of the pregnant woman.

(a) Candida albicans.
This is a fungus, and is a common occurrence in the vaginal region during pregnancy. It is also more common in the diabetic patient (pregnant or otherwise).

It produces a whitish discharge, which may be copious. This in turn causes tenderness, and often a marked itch at the vaginal entry.

Women’s Health

Heart disease

A certain number of women who become pregnant suffer from heart disease. The figure is small, being around 1 per cent or less. Most have suffered from rheumatic disease in earlier life, and this is the cause of their cardiac problems.

Heart disease is a progressive disorder, and each pregnancy will throw an extra burden on this system.

Provided the patient is sensible, carries out her doctor’s instructions, and attends for adequate prenatal visits at intervals which will be more frequent than her healthy counterpart, a satisfactory outcome is usual.

Greater efforts to avoid abnormal weight increases, commonsense care in regard to eating habits, adequate periods of rest, and not performing activities in excess of her ability, all help to keep her fit throughout the term of pregnancy.

The key symptoms that all is not well are breathlessness with activity, and cough. These must be reported to the doctor, particularly if they tend to worsen at any time.

The doctor will want to see the patient every second week from the moment she conceives until the twenty-eighth week. After this, visits will be weekly, or even more often if the doctor has any question. Be guided entirely by his advice. It is most important.

Women’s Health