1st Trimester - Check List
NATIONAL JOURNAL OF HOMOEOPATHY 1999 May / Jun VOL VIII NO 3.
Dr C H Asrani
Patient presents with missed period. Check Urine for pregnancy If +ve.
- Start Folic acid 5mg OD (proved to be BEST for foetal growth in 1st trimester and avoids genetic malformations of the neural tube) if have a substitute in 'H' one can give.
- Check the patient monthly for weight and blood pressure.
- If patient is on any long term medication i.e. for Hypertension, Diabetes, TB, Epilepsy or Asthma, contact the physician involved and discuss the safety profile of those drugs.
- Ask for
Hb with Indices
Blood Group with Rh factor
Urine- Routine
VDRL
HIV antibodies and Hepatitis B Core antigen - For patients with a Bad Obstetric History (BOH) in a past, ie 1st trimester abortions, ask for TORCH (Toxoplasmosis, Rubella, Cytomegalovirus and Herpes) panel and Blood Glucose levels, both fasting and post- prandial. To cut costs, initially ask for only IgG levels in TORCH panel, which indicates old infection. Positivity in any one should make you ask for IgM for that particular disease which will indicate recent infection. In consultation with an obstetrician, relevant steps should be taken.
- If VDRL + VE in titers above 1:16 - treat by 'H' or Penicillin and revert it to - ve
If HIV antibodies are present or Hepatitis B + ve consider termination.
- VDRL, HIV antibodies and Hepatitis B Core antigen must be repeated at 7 months to detect infection contracted later and corresponding steps taken.
- If anaemic, start treating for it.
- If has a race blood group, locate suitable donors for the time of delivery.
- Pregnancy test - ve but patient has symptoms like morning sickness and is almost sure she is pregnant - could be a case of late pregnancy. Either wait and repeat Urine pregnancy test after another 5 days or ask for Serum B- HCG (Beta- HCG) if you suspect an ectopic or it is a precious pregnancy with BOH.
- Pregnancy test not confirmatory. Patient has symptoms like morning sickness and pain in lower abdomen. Let the patient or mother-in-law say it is gas, but patient needs an urgent Ultrasound to rule out an Ectopic pregnancy. Do not for a minute think what else it could be? Be sure it is NOT ectopic and than you have enough time to think of other causes. A patient can literally bleed to death with ruptured ectopic. Even if you pick up 10 ectopics out of 100 you have sent for USG, you would have saved 10 lives and Gynec would admit that 'Yes! A Homoeopath diagnosed this ectopic!'
- Patient with severe Hyperemesis Gravidarum and your Cocculus etc are not helping. Patient is very weak, act soon; do not wait till eternity. Ask for routine urine and specifically for Ketone bodies. Presence will suggest that patient is in Metabolic Acidosis and if not given intravenous fluids, will either abort or damage the foetus.
