Molar pregnancy is the abnormal form of pregnancy which results in the presence of a hydatid mole. The mole consists of cellular growth which contains nonviable embryo implanted to uterus wall and also proliferates in the uterus. Bleeding in the genital tract at fifth or sixth month of pregnancy is the main symptom of molar pregnancy. Early diagnosis and removal of molar pregnancy is needed to prevent complications such as choriocarcinoma, a type of cancer. One mother out of 1000 pregnancies may report molar pregnancy.  Partial molar pregnancy is also one form of molar pregnancy.

Maternal chromosomes are absent in the fertilized embryo of molar pregnancy. While in normal pregnancy 23 pairs of chromosomes are present in the zygote.

Normal number of chromosomes from the mother and duplicate form of doubled chromosomes from father are found in case of partial molar pregnancy. So the total number of chromosomes in case of partial molar pregnancy is 69 instead of 46 chromosomes. In case of complete molar pregnancy the inviable fetus is present. But in case of Partial molar pregnancy some fetal tissue is present. The fetus of partial molar pregnancy has genetical abnormality and the survival rate of fetus is very less.

Symptoms of molar pregnancy:-

* Painless genital bleeding during fourth or fifth month of pregnancy is the main symptom of molar pregnancy.
* Enlargement of uterus than normal level,
* Enlarged ovaries,
* More vomiting or morning sickness during early months of pregnancy,
* Protein urea with Increased blood pressure,
* High levels of chorionic gonadotropin ( HCG) in blood
* Are the main symptoms of molar pregnancy.
* Pulmonary Embolism,
* Hyperthyroidism is because of excess secretion of t4 hormone.
* Rapid growth of uterus,
* No fetal movement is detected in the womb,
* Absence of fetal heart sound while assessing with fetoscope.

Diagnosis of molar pregnancy:-

* Ultrasound or sonogram is the main diagnostic test for molar pregnancy,
* Histopathological examinations are preformed to study the nature of the cells,
* The mole is found like a bunch of grapes with a cluster,
* Enlarged chorionic villi is also observed during diagnosis.

* Hyperthyroidism is also seen in some cases.

Treatment of molar pregnancy:-

• Evacuation of uterus by uterine suction is used to treat hydatidiform of moles.
• Surgical curettage is done soon after the diagnosis of Molar pregnancy.
• Preventing the development of choriocarcinoma is the main aspect of treatment.
• Patient is checked for decreased or nil level of  chorionic gonodotrophin hormone level, which confirms the effective treatment of molar pregnancy.
• Metastatic pregnancy moles are treated with Chemotherapy, and the medicine Methotrexate is also administered to treat cancer type pregnant moles in the uterus.

Patient of molar pregnancy who undergoes treatment are advised not to get conceived till 12 months after treatment.

Carboprost is the medicine used to stimulate contraction of uterus and mole expelled out in some cases.

Diabetes and Pregnancy:-

Untreated diabetes  pregnancy is fatal and need immediate care. Most of the women fails to plan the diabetes pregnancy and may face the number of problems. Obesity may cause diabetes pregnancy in the pregnant mother. Gestational diabetes mellitus is common in nearly 15 % of pregnant women. Carbohydrate intolerance of Gestational diabetes mellitus is seen after 24th week of pregnancy, when placenta  produces  hormones which interfere insulin activity. Maintaining normal blood glucose level is very important during pregnancy to avoid damage to growing fetus. Women with type-2 diabetes mellitus should shift from oral anti diabetic drugs to insulin therapy. Diabetes mellitus also increases the risk of coronary artery diseases. Diabetes pregnancy mother should take care of her health and growing baby’s health.

Diabetes Pregnancy and full Health check up for diabetes during pregnancy is very essential for maintaining health of pregnant mother and growing fetus. The risks of diabetes pregnancy should be reduced before end of second trimester of pregnancy. Oral glucose tolerance test is done to measure the glucose levels in the blood and effective treatment is given to treat diabetes pregnancy. when glucose is present in urine and is in high quantity in blood during pregnancy is said to be pregnancy complicated with diabetes. sometimes lactose may be present in urine which is near labour or during lactation, it is known as lactosuria. glycosuria during pregnancy is usually the result of the renal threshold for glucose, but it is essential to recognise and treat diabetes.

In more than half of the cases of diabetes associated with pregnancy or Diabetes pregnancy the disease is known to have been present before the pregnancy began.

Symptoms of diabetic glycosuria:-

* polyurea,
* polyphagia,
* polydipsia,
* peripheral neuritis,
* pruritus vulvae, etc

The diabetic or renal origin of glycosuria can be differentiated by a simple test. A blood sugar reading is made immediately after the patient has emptied her bladder. Half an hour later a specimen of urine is obtained and tested for sugar, and after a further half an hour a second blood sugar reading is made.

Diabetes pregnancy management:-

The patient must be seen frequently throughout her pregnancy and it is better if a physician and the obstetrician should co operate with each other in treating diabetes pregnancy and preventing bad results for fetus. The onset of hypertension hydramnios is a further indication for hospital management. Diet, exercise, Monitoring weight gain and insulin therapy are the main aspects of treating Diabetes pregnancy.

Diet : Postprandial hyperglycemia leads to increased level of blood glucose. So consuming the diet with the help of dietitian is good for diabetes pregnancy. Diet taken by mother who have diabetes pregnancy should include low glucose diet and a balanced diet with the physicians guidance. Protein malnutrition may occur during pregnancy and care should be taken.

Exercise : Exercises during diabetes pregnancy helps in utilization of glucose from the body and reduces increased glucose level in blood. Exercises for pregnant mother should not be harmful for baby and mild exercises are done with physicians suggestion.

Monitoring weight gain : Weight gain is normal during pregnancy and it should be normal limit. The mother who have diabetes and plans to conceive should take care to reduce weight before pregnancy. Diabetes pregnancy becomes worsen with excess weight gain.

Insulin therapy management : Appropriate and therapeutic dosage of insulin administration is recommended during diabetes pregnancy. Pregnant mother should have a clear knowledge to administer insulin at correct time. Hypoglycemia may occur with insulin therapy as a side effect and attention should be given by pregnant mother to maintain normal blood glucose during pregnancy. After 36th week of pregnancy insulin demand increases as the placental growth stops.

Treatment of  Diabetes pregnancy:-

The diabetes  pregnancy fetus is liable to die in uterus or womb at any time but particularly during the last four weeks of pregnancy. Baby or fetus  weight at this time may exceed that of a child born at time. If the patient is a primigravida with severe diabetes or multipara with a history of previous still births, Caesarean section should be carried out at about the thirty sixth week of pregnancy. In other cases surgical induction of labour may be attempted. The reason for carrying out the Cesarean section is merely to avoid intrauterine death of the fetus, but the child has only a precarious hold on life and the help of the pediatrician is required to tide it over the first few days of life.

Types of Abortions:-

Different Types of Abortions are named on the basis of their causes;

Threatened abortion :  May be caused due to severe anxiety or fear.

Inevitable abortion :  Is of unknown cause.

Incomplete abortion :  The abortion is not complete.

Complete abortion :  No presence of fetus or embryo in the womb after abortion.

Septic abortion :   Caused due to septic infection of reproductive structures.

Habitual abortions and Missed abortion are the other different types of abortions.

Placenta development :-

placenta is a roundish, flat organ, measures about nine inches in diameter and three quarters of an inch in thickness at the centre.

umbilical cord is inserted towards the centre of fetal surface.   maternal surface of placenta is dark and fleshy in appearance and divided into number of cotyledons by septa which grow from the decidua.

first step in development of placenta is the formation of chorionic villi by which the little ovum attaches itself to the walls of the implantation cavity.

cytotrophoblast sends out definite buds which grow outwards through the syncytium.

mesodermal core grows out to the very tips of the epithelial branches, also called chorionic villi.

as the ovum grows the capillaries becomes more thinned out and the villi attached to it gradually.

Placental infection:-

*  Bacterial inflammation of placenta is called as placental infection. Usually the fetal surface of placenta is infected, particularly the chorion and amnion.

*  Perivascular leukocytic infiltration of the cord and placental fetal vessels are typical of omphalitis or placentitis.

*  Placentitis is commonly a precursor of puerperal sepsis, which causes maternal morbidity and mortality.

Complications of placentitis:-

*  Fetal pneumonia,

*  Omphalitis and stroemia

*  chorioamnionitis  .

Pregnancy:-

Pregnancy is the physiological state of child bearing or women who have growing fetus in the womb is known as Pregnant and the state is called pregnancy. There are some signs usually seen with pregnancy. These signs caused because of physiological changes in the body during pregnancy is called as Pregnancy signs. Early signs of pregnancy are discussed in this article.

Early signs of pregnancy are seen in the earlier stage of pregnancy, soon after some days of conception. early pregnancy symptoms are seen after the  fertilised egg attaches to the uterine wall  itself. Fertilized egg takes some days to attach to the wall of uterus. Number of women get a question themselves, am i pregnant ? when the menstrual is missed. Along with missed menstrual period some of the signs are associated with early pregnancy and later stage of pregnancy.

Early signs of pregnancy:-

Food carvings : is the early sign of pregnancy. Is a tendency to eat some particular foods. This sign may not be seen in most of pregnant women. The common food items liked by pregnant mother are pickles, orange, mosambi and other sour fruits, vegetables etc. Abdominal bloating is also the sign of pregnancy.

Swollen, Tender Mammary glands : Mammary glands becomes tender and swollen because of changes in estrogen and progesterone hormone level. The glands starts to undergo changes for milk secretion and feeding the baby after birth. The pain  will subside after some days when body adjusts to the hormone surge.

Dark areolas : The areola is the place around the nipple of female mammary gland. This part becomes darker after the women gets pregnancy and it may confirm the women is  conceived.

Missed period : The important and compulsory sign of pregnancy is missed menstrual period. The women misses one period may go for pregnancy test and in most of normal healthy women missed period is the early sign of conceived pregnancy. Increased level of progesterone hormone causes missed period.

Implantation bleeding : The bleeding occurs after the fertilized egg is implanted to wall of uterus. Implantation bleeding occurs nearly 8 days after ovulation. Spotting is experienced  by women after some days of conception. This is earliest sign of pregnancy experienced by the pregnant women.

Frequent urination : The changed shape of uterus puts pressure on bladder, this makes you go for bathroom often and often. The growing embryo produces human chorionic gonadotropin ( HCG) hormone causes frequent urination in pregnancy mother. This sign is usually seen after two or three months of pregnancy.

Fatigue with tiredness: The increased level of progesterone hormone  make to feel tiredness even with doing daily living activities. Fatigue is one of the early sign of pregnancy. The blood supply is also reduced to hands and legs, as the blood supply increases to vital organs such as uterus.

Morning sickness or Nausea : Morning sickness or Nausea is the earliest sign of pregnancy seen after some weeks. The women feels vomiting sensation to eat even small amount of food. Increased hormone level may lead a women to get nauseated  whole day. Nausea may present even at night time.

Altered taste or sense : Common complaint by most of women who have pregnancy is the feeling of  metallic taste in mouth. They may not taste coffee, tea and other foods properly. This problem is not noticed all pregnant.

Pregnancy confirmation : Pregnancy  test confirms the women is conceived. as soon as the women knows she missed a period, she can go for pregnancy test, and is the important sign confirms pregnancy scientifically. Urine  Pregnancy  test  is the commonly done test.

Mood changes : Mood swing is also seen in pregnant mother. Emotional changes are noticed by the mother and may get anger, depression, and other mood changes. Increased hormone level is main cause of this.

Headache : Headache may not be present in all women but seen in most of pregnant women.

All above mentioned signs are the early signs of pregnancy.

Pregnancy :-

The mother who have a growing fetus or embryo in the womb is considered as pregnant women. The pregnant women experiences certain symptoms, which are the changes seen after conception are called as Pregnancy symptoms.

The symptoms of pregnancy are usually common in most of pregnant women but the earliest symptoms of pregnancy may vary from women to women. The symptoms of pregnancy may start earlier in some women and may be delayed in other pregnant women.

Missed menstrual period is  earliest symptom of pregnancy. After the mother is conceived, the zygote is formed in the womb and no shedding of endometrial blood vessels takes place. So the menstrual cycle stops temporarily and the pregnant women experiences Missed menstrual period.

Early symptoms of pregnancy:-

Implantation bleeding is the earliest  symptom of pregnancy.  After 6 t0 12 days of conception, the pregnant women experience spotting and also some cramping. This is because after the embryo implants to uterine wall, the implantation bleeding occurs only in some women but not all.

As soon as the women comes to know the period is missed or delayed, she go for pregnancy test and checks for pregnancy. Even a miss of one period is the earliest  symptom of pregnancy. No bleeding occurs in pregnant women in the early days. Bleeding may occur in the third trimester.

Swollen, tender Mammary gland:
The pregnant women experiences tender or swollen mammary gland. This is also the earliest  symptom of pregnancy felt by the mother. Pain is common while pressing these milk glands. Is mainly because of change in the hormonal level. The changes occurs in the mammary gland to prepare for milk secretion and to feed the baby. this leads to swollen or tender glands.

Fatigue and Tiredness:
Fatigue and tiredness are common in pregnant women, because of changed hormonal levels and emotional worries of the mother. Heart pumps much blood to bring nutrients for growing fetus in the uterus and extremities get less blood flow; this leads to fatigue. And body also struggles to accommodate to changed hormonal levels, this consumes excess energy and causes tiredness in pregnancy women.

Nausea or Morning sickness:
Nausea or Morning sickness are the main symptoms of pregnancy. most of the pregnant mother feels vomiting sensation in the early morning or whole day. Only some women won’t experience nausea or Morning sickness. The elevated hormone affects the digestive system and increased estrogen level makes some smells very sensitive to gastrointestinal tract. This causes the earliest pregnancy symptoms, nausea or Morning sickness. Coffee, dairy products, meat may cause vomiting sensation in the pregnant mother.

Backache:
Due to growing fetus, the shape and size of uterus is altered. So the lower back pain is experienced  by the pregnant mother.  Dull backache is usually present for entire extent of pregnancy.

Headache:
Raised hormonal level in the body dilates the cranial arteries and causes Headache. Headache is not a common symptom of pregnancy in all pregnant women.

Frequent Urination:
Growing fetus changes the position of and shape of uterus. The uterus compresses the urinary bladder which stimulates frequent urination. This symptom of pregnancy  is seen after 6 to 8 weeks of conception.

Dark Areolas:
The changed hormonal level leads to dark coloured areolas. The area around the nipple of mammary gland is called areolas and is becomes dark during pregnancy.

Strong desire to eat certain foods:
Such as  pickles, ice cream, sour items, etc. This symptom disappears after some weeks of pregnancy.

Some pregnant women may experience nausea in the morning and other may experience the nausea whole day. Pregnancy nausea is different from woman to woman. Usually pregnancy nausea is experienced up to three months and some pregnant women will have morning sickness till 5 to 6 months.

Pregnant mothers need good nutrition in order to provide nutrition to growing fetus. Pregnancy Nausea or morning sickness makes the pregnant mother to hate food or to lose interest in taking food. So the frequent food intake and nutrient food intake helps in providing essential nutrition to pregnant mother.

Causes of pregnancy nausea or morning sickness:-

• Causes of pregnancy nausea are not known exactly. It is believed that changed hormonal levels in the body and imbalanced sugar levels may lead to morning sickness or pregnancy nausea.
• Elevated level of hormones causes nausea or vomiting for first 8 to 14 weeks. Increased estrogen level makes  mild smell to grow more powerful. This provokes nausea and leads to vomiting. The elevated hormones level in pregnant women effects the gastrointestinal system or digestive tract.
• Emotional stress and fatigue in pregnant women also causes pregnancy nausea or morning sickness.
• A number of midwives and  doctors state morning sickness is high in mothers who carry  twins or triplets, and is not yet proved scientifically.

Effects of pregnancy nausea:-

• The frequent vomiting during pregnancy leads to excess fluid loss from the body. Along with fluid, nutrition and minerals are also lost with vomiting and it leads to dehydration. If the dehydration is severe the pregnant women experience symptoms such as dizziness, thirst, passing very less urine, urine is dark in colour.
• Most of the women neglect nausea and vomiting during pregnancy. when the mother becomes dehydrated, if enough fluids are not restored it leads to condition called hyperemesis gravidarum  and medical treatment is needed. Intravenous fluids are administered to treat hyperemesis gravidarum in pregnant mother.

Tips to avoid Pregnancy Nausea or morning sickness:-

• Avoiding Pregnancy Nausea or morning sickness during Morning
• Don’t get up suddenly from the bed.
• As soon as you wake up sit on the bed take rest for five minutes.
• If feel like vomiting, eat a biscuit after cleaning mouth.
• Take light food such as bread and jam but not breakfast in the early morning.

Avoiding Pregnancy Nausea or vomiting  during day time:-

• Don’t eat much food at once.
• Don’t eat as the stomach becomes full with one time food.
• Eat frequently in small amounts.
• Don’t wait until you feel much hungry.
• Maintain blood sugar level normal by taking frequent, protein rich diet.
• Protein rich diet is better than taking bulk of starch.
• The favourite food with good taste may not induce vomiting,
• Drink enough water nearly 2.5 to 3 liters a day.
• Fruit juices are good for pregnant health.
• Have a cup of tea during midday, between meals.
• Avoid spicy and curries as much as possible.
• Alcohol and caffeine are not suggested to take during pregnancy.
• Toasted bread or rusks  can be eaten.
• ginger tablets or ginger tea helps to reduce Pregnancy Nausea.
• Avoid sudden movements and move slowly while changing body position.
• Don’t lay on the bed soon after having food. sit for some time or walk some steps.
• Don’t take the food which you don’ t like.
• Walk some steps in the home itself to avoid morning sickness.
• Smoking and alcoholism are not good for pregnant health.

Avoiding night time pregnancy nausea:-

• Eat snacks such as yogurt, bread, warm milk, cereals and  sandwich before going to bed.
• If you wake up at night, drink a small cup of water and take a spoon of sugar to reduce chances of pregnancy nausea.
• Sleep in well ventilated room to breath fresh air.

When to meet doctor   ?

When all these measures fail you can meet the doctor

* If vomiting is severe,
* If you feel thirsty always and not able to consume food,
* Vomiting with blood or dark brown fluid,
* If you have symptoms of dehydration,

And if the vomiting or pregnancy nausea makes you to worry, the pregnant mother can meet doctor and can get relief.
Medical treatment of pregnancy nausea:-

urine test for ketones helps diagnosing Dehydration related to nausea and treatment is given on priority.

Anti sickness tablets are prescribed to reduce pregnancy nausea or morning sickness.

Abortion:-

Most of the time  the couples surrender to an  unprotected sex, and fails to any contraceptive or may ignore it. During the absence of menstruation next month, the lady come to realize to doubt of pregnancy.  She will get the pregnancy strip and confirms her pregnancy.  What to do ? how to remove unwanted pregnancy ?  any abortion pills ?  how does an abortion pill works ?  is abortion pill is safe ?  here is an answer for all these abortion related questions:-

Abortion pill:-

To terminate the unwanted pregnancy the medicine mifipristone  was introduced and also accepted as abortion pill in the year 2000 in united state. Mifipristone is known as RU486 in US.  The drug mifipristone was first introduced in France and over all controversy the drug has been approved as As abortion pill.

Terminating an unwanted pregnancy is known as abortion. Till  the 49th day of pregnancy can be terminated using medicine,  i.e.  Abortion pills.  The doctor will confirm the pregnancy, commonly using pregnancy confirmation strip.  Once the pregnancy is confirmed, under the act of medical termination of pregnancy, if the pregnancy is earlier or below nine weeks  the ABORTION pills are given by the doctor.  US FDA has approved RU – 486 as abortion pill.

Medical termination of pregnancy using Abortion pill has much benefits over surgical methods of pregnancy termination.

Who can take abortion pill ?

Women who are pregnant not more than 49 days or 9 weeks can take abortion pill mifipristone for pregnancy termination. Women with kidney, liver, heart disease or HIV can’t take the abortion pill, as abortion pill is contraindicated in these diseases.

Mifipristone or RU – 486 can be taken at the clinic or home.  Abortion pill or mifipristone  dilates cervix, and contracts the uterus as the embryo can be expelled out.  Mild discomfort is common with mifipristone.

Side effects of abortion pills

* Nausea,
* Headache,
* Discomfort,
* Heavy bleeding
* tiredness, and
* Deep cramps,  are the common side effects of abortion pill RU – 486.

Severe side effects of abortion pills  are :-

1. Severe bleeding more than 12  hour,
2. Unbearable contractions of uterus,
3. Big clots associated with bleeding,
4. Fever morethan101.5 degree F, more than 6 hours,
5. Allergy soon after the abortion pill is consumed.

Self medication is dangerous and a prescription by the registered physician and effective medical supervision is needed to avoid any complications of medical Abortion with Abortion pills.