Labor induction:-

Artificial process of starting labour or stimulation of child delivery using medicines is called as Labor induction. Labour induction is done when labor is not started normally and the birth of baby has to be taken place in order to save life of both mother and baby.

Need for Labour induction:-

* Post dated delivery more than two weeks, If labor is not induced the baby becomes large and it becomes a fatal condition.
* When no uterine contractions started after rupture of membranes,
* Maternal increased blood pressure or Eclampsia, or preeclampsia,
* Infection of uterus and birth canal,
* Pregnancy with Diabetes,
* Less amniotic fluid around the baby.

In all these conditions labor induction is done by the doctor or obstetrician.

Procedure of Labor induction:-

Labor can be induced by different methods. Before induction of labor, the cervix is checked for softness or any dilation of cervix. If cervix is not open a medicine is placed in the cervix region. The medicine helps in softening and opening of cervix.

Rupture of amniotic sac is also done with the finger or with the help of amnihook and it also starts Labor. In some cases labor does not start even after the water comes out from the amniotic sac. The rupture of membranes may cause infection if proper hygienic methods are not taken.  Keen observation is done to take any measures to conduct delivery of the baby.

Oxytocin is the medicine given to induce the labor. Usually the medicine oxytocin is given through intravenous ( I V ) route. Strong and regular uterine contractions are started after the administration of Oxytocin.

When oxytocin fails to induce labor, the Caesarean section is done to take out the baby from the womb of mother.

Pitocin is given in some mothers to induce labor.

First month pregnancy:-

First month pregnancy is also called as fetal bud stage. The first month of pregnancy starts from the day of last menstrual date to four weeks of pregnancy. Size of fetal bud in first month is around 0.5-1 cm. The heart and spinal cord of fetus develops in the first month of pregnancy. So special nutritional care is important for the pregnant mother. Pregnant mother who uses Folic acid tablets can prevent any abnormality in the prevention of Defects of growing fetus during first month of pregnancy.

Symptoms of First month pregnancy:-

Missed monthly period:  It is the main symptom of First month pregnancy. As the egg is fertilised, the zygote is formed and the menstrual period is missed.

Fatigue:  Women feels so tired, and thinks how to combat fatigue and perform or continue work.

Mood Swings and Depression: Women with first month pregnancy experiences Sudden mood changes, and even for a loneliness they get Depression very soon.

Morning sickness:  Women feels vomiting sensation in the early morning as soon as they wake up from the bed. Most of the women with pregnancy experiences Morning sickness. The hormonal changes leads to Morning sickness.

Excessive Salivation: Excessive salivation is also associated with first month pregnancy, due to changed hormonal levels in the body.

Excessive urination:  Due to change in the position of uterus and hormonal changes Women with pregnancy passes urine often and often.

Increased size of Mammary Glands, is also because of change in estrogen and progesterone level.

All these symptoms are seen in first month of pregnancy. Pregnancy home test is done to confirm pregnancy, or the pregnancy confirmation is done by the physician in the health care centre. Most of the women becomes very happy with their first pregnancy.

• Mother get both physical and mental surprises during second pregnancy.
• During first pregnancy tugging,  pulling and expanding a month sooner is common. this may not be seen earlier during second pregnancy.
• Fetal movements in the womb are easily recognised during second pregnancy.
• Painful Braxton-Hicks contractions are more during second pregnancy than first pregnancy.  These uterus contractions are more during third trimester of pregnancy. In multi para mother or during second pregnancy, uterus contractions are frequent and reduces in later stage.
• During first pregnancy mother will have some fear about pregnancy and emotional instability. This emotional stress may be reduced during second pregnancy.  Different trimesters of pregnancy and labour process creates fear during first pregnancy.
• Since the mother has already the partner care may be reduced if he is busy, but most of partners provide care as in case of first pregnancy.

Tips and facts:  second pregnancy:-

• Nausea is also present during second pregnancy , but during second pregnancy mother learns to manage nausea.
• Mother should increase emotional involvement and attachment during second pregnancy.
• Large mammary glands are present during second pregnancy. The size is increased because of feeding the baby last time.
• Large belly : stretched uterus makes the big belly and extended stomach.
• Skin changes : Are also present in second pregnancy, during second trimester of pregnancy. Skin becomes darker and areola becomes darker.  Skin pigments are also found on the face of pregnant mother.
• Heartburn and constipation :  heartburn and constipation are experienced by women, in the second or third trimester, during second pregnancy also.
• Mother should undergo blood tests, urine test, and ultrasound scan during second pregnancy.
• Do the pregnancy exercises and consume healthy nutrient and balanced diet.
• Hospital visit should be followed as first pregnancy, tetanus toxoid dose is must for second time pregnancy also.
• Take care of first child and provide some dolls for the child to play. The child should not feel its getting less care and love from mother.

Third trimester is the vital stage of pregnancy, at the end of this the child’s birth occurs. Also the fetal growth is high during third trimester pregnancy, all the parts of baby are mostly developed at the end of third stage. Last three months of pregnancy are physically and emotionally challenging to mother.

Third trimester pregnancy and women – Facts:-

* Third Stage of pregnancy is the vital stage of pregnancy. Third trimester pregnancy is physically and emotionally challenging for women.
* Mother prepares to give childbirth of her lovely baby.
* Pregnant mother becomes uncomfortable with the physical changes and internal changes.
* Rapid growth of baby occurs in third trimester pregnancy as compared to previous months.
* Mother should avoid alcohol and smoking.
* Tetanus toxoid injection should be taken by the mother.
* Iron and folic acid tablets are taken by the pregnant women during third trimester pregnancy.

Fetal changes during third trimester of pregnancy:-

* Fetal brain is well developed
* kidneys and lungs starts maturing but not functional.
* Fetus can hear external sounds
* Fetal head engaged at 36Th week of pregnancy. Head engagement is the process of fetal head drops into pelvic area. This process is known as lightening.
* Fetal skull bones remain soft as they can easily pass the birth canal.
* permanent eye colour is not developed during fetal life. Iris may be blue.
* Between 38 and 40th week of pregnancy, lanugo of baby may be disappeared.
* Lung get matured at 40th week of pregnancy.
* Baby in the fetus is covered a creamy, protective coating on the skin called vernix caseosa.
* Baby is present in flexed position in the womb of mother/ fetal life.
* Near the end of third trimester, baby turns downward

Changes in women during Third trimester pregnancy:-

* Mother may feel hot as the fetus radiates body heat, mother’s skin temperature is Increased.
* Frequent urination troubles the mother as the uterus compresses urinary bladder.
* Fetus compresses the main vein which returns venous blood to heart. this leads to low blood pressure during end of Third trimester pregnancy.
* Fluid retention in mother leads to Swelling of ankles, hands, and even face. Ankle edema is even associated gestational hypertension.
* Increased hormone levels in body stimulates hair follicles and excess hair may grow on pregnant women arms, and legs.
* Leg cramps are also found during third trimester pregnancy.
* Women experience backache due to altered body shape as the growing fetus causes abdomen to bulge. Backache increases with third trimester pregnancy.
* Constipation, indigestion, and heartburn are common during third trimester pregnancy.
* Varicose veins are the dilated veins in the legs are found in some pregnant mother.
* Women feels false uterus contractions called braxton-hicks contractions.
* Stretched marks are appeared on the abdomen, and muscles of thighs and buttocks during third trimester pregnancy.
* Milk or Colostrum, may leak from mammary gland as a clear fluid as a preparation of lactation.
* Stretched abdominal skin causes dry and itchy skin during end of third trimester pregnancy.
* Sexual urge is very poor in most of women during third trimester pregnancy.
* Dark patches are found on facial skin like butterfly structures because of Skin pigmentation.
* White mucus may be discharged during later stage of pregnancy.

Tests done during third trimester pregnancy:-

*      Mother’s weight and blood pressure are checked during third trimester as they are important in assessing health of women and baby.
*      Urine test is done to detect albumin which may indicate preeclampsia or toxemia, and increased blood sugar or hyperglycemia.

*      Ultrasound scan is done to identify the growth and development of fetus and health status of growing baby.

*      Growth and development, and position of fetus are checked.

*      Height of the fundus is measured ( height of uterus).

*      Fetal heartbeat is measured with fetoscope.
What the pregnant mother should follow ?

*      After 29th week of pregnancy, prenatal visits should be given for two weekly once.

*      After 36th weekly once hospital visit is preferred.

*      During 38th week of pregnancy, Pelvic examination is done to determine the dilation and effacement of the cervix.

*      Mother should not be panic about labour.

*      Get adequate information from the your doctor about procedure carried out during labour.

Definition and Description:-

Starting of labour before the term  between 20th to 37th week of pregnancy  is known as preterm labour.

The contraction of uterus and dilation of cervix to give birth to child is called Labour. Early starting of labour before the completion of gestational age is called as Preterm Labour.

Preterm Labour is one of the challenging complications in the obstetrics. The cause of 75% of neonatal deaths is Preterm Labour. Nearly 1 out of 10 deliveries is preterm labour in the united states. Even though the exact cause of preterm labour is not known, by reducing the risk or predisposing factors the rate of preterm labour can be controlled.

Risks of preterm labour:-

• Due to Early delivery, the fetus is not completely developed and the chances of neonatal deaths are high.
• Preterm labour baby after 32th week may sustain as the death risk is reduced.
• In earlier deliveries before the 24 th week, the survival chance of the neonate is very low.
• The survived preterm babies may have, long term health problems.
• Preterm babies may have reduced growth, less intelligence, etc.
• Mothers may get emotionally upset.

Causes of Preterm Labour:-
The exact cause of preterm labour is not known, but the problem with baby or mother or both may cause preterm labour. Most of the preterm labours are natural and some are caused by the use of medicines and are said to be medically induced.

• Placenta abruptio : placenta separates from uterus earlier.
• Pre eclampsia : increased blood pressure or hypertension during pregnancy.
• low social economic status of mother,
• previous history of second trimester abortion,
• Previous history of preterm labour,
• Infection of the mother’s uterus leads to contraction of uterus and causes preterm labour.
• Multiple pregnancy : having more than one fetus in the womb.
• Uterus diseases, or cervix disorders.
• Bursting of amniotic sac before contraction of labour,
• Alcohol or smoking by the mother during pregnancy.

Symptoms of Preterm Labour:-

It is difficult to suspect the preterm labour as it starts earlier. The nature of contractions will be as follows.

• Contraction of uterus, more than 8 times, per hour. The belly becomes firm due to uterus contractions.
• Pink or reddish fluid discharges from the genital organ, may leak or gush out.
• Pain similar to menstrual cramps, may be with or with out diarrhoea.
• Increased pressure in the pelvic region or lower belly.
• Premature rupture of membranes,
• Dull lower back pain, pain in the thighs, lower abdominal discomfort, etc.
• discomfort, weakness, fever may be present.
• Braxon hicks contractions are the painless small contractions which are normal. Careful assessment should be done to identify preterm labour pain.

Diagnosis of preterm labour:-

* The thorough physical examination helps in diagnosing preterm labour. Dilation of the cervix, rupture of membranes, presence of any infections are found during physical examination.
* Urine blood tests to identify infection and other significant results.
* Ultrasound scan, fetal heart rate gives the activities of babies in the womb.
* Amniotic fluid is tested to identify infection.

Treatment of preterm labour:-

* Medications are given to postpone the suspected preterm labour, but it is not the effective method.
* Antibiotics are used to treat infections of the uterus, and an infection caused by the amniotic fluid.
* Steroids are administered to increase the survival rate of the baby.
* Treat associated problems with pregnancy,
* Don’t try to avoid labour if the uterus contractions are severe and cervix has dilated, as the delay may harm the mother’s health.
* Tocolytic therapy is also given to treat preterm labour.
* Magnesium sulfate and other drugs are used.

Presentation of breech during delivery, instead of head presentation is called as Breech presentation.

Breech birth difficulties:

• The buttocks may be arrested near the pelvic brim.
• Buttocks may be arrested at the outlet of the pelvis, usually from extended legs.
• The extension of arms prevents the delivery of head and shoulders.
• The head may be arrested in the pelvic cavity or even above the brim.

Causes of breech birth

• Multiple pregnancies,
• Polyhydramnios or excess amniotic fluid,
• Fetal anomolies, such as congenital abnormalities,
• Uterine abnormalities,
• postdated labour,
• poor antenatal care

Drugs and pregnancy:-

Pregnancy is the very vital state for every women. A Women becomes mother after giving birth to baby. The women is going to give birth to the baby which resembles the parents usually. As the fetus or baby grows in mothers womb, an external additional nutrition supplement is essential for mother to nourish the growing baby. So during pregnancy the mother should receive healthy food which is good in nutrients. Good food ingestion results in maintaining good health of both mother and baby or fetus.

How drugs affects mother’s and fetal life ?

Drugs taken by the mother during pregnancy affects the mother’s health and also the fetal life affected lot. Even the drugs or medications taken to treat infections or diseases of pregnant mother affects the growing fetus.

All narcotic drugs are contraindicated for pregnant mother as the deviation of mother’s health and destruction of normal fetus growth is definite. The drugs such as heroin and cocaine are very dangerous for both mother and fetus. Even alcohol and tobacco alters the health of mother and fetus. Most of the medications drugs taken to treat an infection or disease are harmful to fetal life. Pregnant women health is also altered with medications. So preventing the diseases and infections is the best way avoiding drugs during pregnancy.

At what stage drugs affect pregnant mother and fetal growth ?

Certain drugs affects the fetal life at different stage of growth. A drug may not damage pregnant women health the fetal growth during one trimester and the same drug may cause damage at another stage of pregnancy.

Most of organs and systems of fetal body are developed in the first ten weeks of pregnancy. During formation of body organs and systems of baby, the drugs and medications consumed by the mother affects the growth of fetus and growth may be deviated. The deviated growth of fetus leads to fetal malformation of developing organs such as heart, limbs, spinal cord and facial features. +

Some drugs dangerous during third trimester of pregnancy. The drugs given during later stage of pregnancy may trouble the mother during labour or affects the fetus. Even the adverse effects of drugs may harm the baby after birth.

How alcohol is dangerous to health of women and baby ?

Alcohol is the most dangerous drug for pregnant women, that too in early weeks of pregnancy. After entering the body alcohol is converted into cell-damaging compound, the chemically can be absorbed from fetus easily. Cluster of birth defects are high with Heavy drinking during early weeks of pregnancy. Fetal alcohol syndrome is the common problem seen in the babies born to alcoholic mother. The defect includes small skull, abnormal facial structures, and heart defects ( hole in heart ) and even impeded growth and mental retardation are also manifested in the baby.

Doctors suggest that Is better for mother to avoid alcohol during pregnancy. If the mother avoids the alcohol during pregnancy, is good for both pregnant mother’s health and fetal health. Is not an alcohol is great worth than a normal baby. is not it ? Then stop drinking alcohol and enjoy the safe motherhood.

Smoking and health of fetus and pregnant women:-

miscarriage or premature labor are common when the mother have an habit of Smoking during pregnancy. Nicotine depresses the appetite and pregnant women refuses food. This reduces the nutritional intake by the mother at prime time and mother becomes weak and also the fetal growth is affected. Less nutrient supply to mother and fetus may result in low birth weight of newborn baby. Lungs of mother also fails to absorb maximum oxygen and the baby may suffer from lack of oxygen.

Drug abuse is very very dangerous:-

Cocaine and methamphetamine strongly stimulants the central nervous system and suppress pregnant mother’s appetite and causes drastic forces women’s body. This leads to constriction of blood vessels, and increases heart beat there by increases blood pressure. Ultimately hinders the fetal growth. Risks of miscarriage and premature labor are common with cocaine use. Abruptio placentae a condition in which placenta is partially separated from uterus is also occurs with usage of narcotic drugs.Drugs or medications Affects mother and fetus/ baby NSAIDs : non-steroidal anti-inflammatory drugs such as nimisulide, and other analgesics such as aspirin, ibuprofen interfere with blood clotting and increase the risk of uncontrolled bleeding during labour from mother and from the cord of the baby. Labor may be dangerously delayed or extended when these drugs are taken at the end stage of pregnancy as by hindering production of the hormones that stimulate labor.

Drugs used to prevent epileptic seizures are called Anticonvulsants such as phenytoin and carbamazepine may cause defects of heart and face, and also may lead to mental retardation.

Drugs used to treat chronic acne and psoriasis such as Isotretinoin and etretinate may cause chronic malformations during first trimester of pregnancy.

Anticoagulant drugs used for treatment of heart disease and stroke, affects clotting and prevents platelets aggravation.When these Anticoagulant drugs used during early pregnancy, may cause facial malformations and mental retardation. If taken during third trimester of pregnancy increases risk of uncontrolled bleeding during child birth.

Drugs used to treat migraine (Anti migraine drugs) such as ergot amine and methysergide increases the risk of premature labor.

Rh incompatibility :-

Rh factor is the protein present in blood and blood groups are termed positive or negative on the basis of Rh factor. If mother is Rh-negative and father is Rh-positive, the mother may get aborted because of Rh-incompatibility.

When Rh antigen introduced into the circulation of Rh negative person, it stimulates the production of antibody in the form of agglutinin. Two forms of agglutinins are  formed i.e Albumin agglutinin and saline agglutinin.

In Rh sensitised mother, antibodies can be detected at 34th week of pregnancy. Usually the Rh-compatibility test is conducted twice during pregnancy. If  the mother is sensitised during last pregnancy, antibodies are found  in the early stage of next pregnancy.

Blood group of only 15 to 17% are Rh negative. The appearance of antibodies for first time in the later stage of pregnancy indicates, the fetus is stimulating maternal antibody production.

Oral contraceptives:-

Oral contraceptives are the the pills of Oestrogen and progesterone, hormone compounds. The oral contraceptives need to be  taken after fifth day of menstruation till 24 day to avoid unwanted pregnancy. much care has to be taken while taking oral contraceptives:

*  If patient forgets to take tablet on particular day, two tablets can be taken in the next day.

*  Cigarette smoking increases the risk of side effects with oral contraceptives.

*  Nausea or vomiting sensation is the common symptom associated with Oral contraceptive ingestion.

*  Oral contraceptives are the effective measures of preventing unwanted pregnancy.

*  Fluid retention and Break through bleeding are the other side effected find with oral contraceptive.

*  Diabetes may be aggravated with oral contraceptive use.

*  Oral contraceptives come in pockets of 21, 23 or 91 tablets.

*  Seek medical help if you find any discomfort or Side effects.

Pregnancy infections may cause damage to growing fetus or baby.  The medications or drugs used to treat pregnancy infections also cause drug induced damages to both mother and baby.

Common pregnancy infections:-

Common cold and flu :-

Common cold is the common Pregnancy infection occurs in pregnant women. As the cold is common infection women are also affected. Usually no treatment is needed to treat common cold. Even with or without treatment cold subsides after a week. If Common cold and flu are not sever avoid drugs. Drink plenty of water and take protein rich diet.

Thrush :-

Thrush infections are common in pregnant mother.  Chlamydia infections are usually caused by  yeast such as Candida albicans. Candida albicans is commonly found in genital tract up to 16% in non pregnant women and up to 32 % in pregnant mother.  Itching, soreness and  white discharge are the common symptoms of thrush pregnancy infections. Thrush pregnancy infections are rare in first pregnancy, and seen during second or third time pregnancy and during third trimester of pregnancy and risk is increased during summer. Women with diabetes, following antibiotic course, are at risk of thrush pregnancy infections.  Clotrimazole solution is the treatment of choice to treat thrush pregnancy infections.
Group B Streptococcus infections :-

Group B streptococcus is the bacteria  present in pregnant women genital tract, and causes no problem to women.  some women get infected from group B streptococcus and treatment is given with antibiotic ointments. antibiotics can be given orally also.

Sexually transmitted diseases :-

Chlamydia and gonorrhoea are the common infections during pregnancy. pregnancy infections infect the baby during delivery and causes eye infections. Gonorrhoea is very rare and occurs in less than 1 women out of 1000 pregnant women. Chlamydia is the more common pregnancy infection, occurs in nearly 5 % of pregnancies. Chlamydia also lead to chest infections in the baby or may infect the lining of mother’s womb soon after delivery. After screening the Chlamydial and gonorrhoea pregnancy infections using swab, it can be treated effectively.

Urinary tract infections :-

Urinary tract infections are common in pregnant women because the urine flow from ureter to bladder is altered. Most of the pregnant women get UTI, it is the most commonly occurring among pregnancy infections.

Toxoplasmosis :-

Toxoplasma gondii, is the parasite that cause infection in pregnant women. Symptoms of Toxoplasmosis pregnancy infection is similar to flu and glands becomes swollen in neck region.

Chicken pox : -

Is very rare infection but if women are infected it severely damages . So mother should prevent this pregnancy infection by avoiding contact with Chicken pox affected  individuals. Immediate medical care is needed to avoid complications in baby and mother.