Care During 1st Trimester
NATIONAL JOURNAL OF HOMOEOPATHY 1999 May / Jun VOL VIII NO 3.
Dr. Nilesh Baxi

1600 women per day (ie. 5, 85, 000 per yr) die every year due to causes related to pregnancy- this is largely because of poor care during pregnancy - both in terms of medical attention and poor nutrition. A major thrust is required to provide better care and reduce the disability and death, both of mother and newborn. This can only be achieved if primary care physicians like us take on this mammoth task of monitoring and making the pregnancy safe.

Why is care during 1st trimester so important? It is so because most of baby's important organs form very early. Birth defects may happen BEFORE a woman has missed a period and knows she is pregnant. One can lower the risks of birth defects and pregnancy problems by advising better health choices BEFORE & DURING pregnancy.

What are the risks to the foetus?
To name a few:

• Infection or sequel of earlier infections that may transmit from mother, one has to be very careful about German measles, STD, HIV, Hepatitis B.
• Problems that may occur due to poor nutrition.
• Trauma
• Ailments that the mother is likely to suffer from e.g. Hypertension, Diabetes Mellitus, Epilepsy.
• Harmful effects of medicines taken by the mother, deficiency states in mother or
• Problems likely to be encountered during delivery and immediately afterwards.

What Is Pre-Conception Care?
Getting fit before one gets pregnant. PCC is important for all the would - be - pregnant mothers. It is a must for those who find conceiving difficult and have Abortions, still births, Bleeding during pregnancy, low birth weight babies, High blood pressure, Diabetes or any other complication earlier. And who else but a primary care physician is better suited for the job?

An apparently mild illness such as German Measles (Rubella), and Exposure to radiation (X-rays) and drugs (even OTC drugs) for first three months, may cause problems. Women < 18 > 35 who have babies are more likely to have problems with pregnancy or small babies.

Precautions:

1. All drugs to be avoided (except Homoeopathy).
2. Diet- balanced . Diet: Eat plenty of protein, vegetables. Protein is found in milk, hard cheese, paneer, meat, fish, pulses beans and peas. Whole wheat cereals and green leafy vegetables are good sources of some vitamins and minerals. Most people should probably cut down on fat, so one could eat white fish rather than red meat, and trim off any fat. Skimmed milk may be helpful. Should not eat fried or oily food.
   Recommended Ratios:
   Fats & Sweets (minimal amount ) Milk & Milk products / Meat & Protein foods (moderate amount)
   Vegetables / Fruits / Grain products (maximum amount )
3. Fe & Ca Supplement,
4. Personal cleanliness & hygiene
5. Exercise : Walks, Yoga or general exercise according to the stage of pregnancy + pelvic floor exercise + post delivery
6. Rest & Relaxation
7. Positive Mental Attitude
8. Sunshine & Fresh air, if possible
9. Pets & Cats - one should not handle cat litter.

1st Trimester - Generally with FP unless there is adverse past history.
Folic acid throughout. Safe medicine for vomiting as advised by your doctor + small frequent feeds.
Monthly record of BP & weight. Normal activity to be carried on including sexual . Jerks and excitement should be avoided. Should spotting or bleeding occur, one must contact a doctor. Do not forget to give all possible relevant history to your doctor.
Risk of miscarriage is the greatest in 3rd month. Weight gain starts from 3rd month onwards.

Safe Motherhood- Actions Required

1. Delay child bearing ; Age at marriage 21 : spacing of pregnancy.
2. Ensure skill attendance at delivery. Mid wife / Dai centers
3. Improve access to maternal health services - more centers
4. Improve the quality of maternal health services
5. Identification of high risk pregnancies
   1. Timely referral of high risk cases
   2. Prevent unwanted pregnancies
   3. Better FP services
   4. Address unsafe abortions, cause problems in future in pregnancies like Ectopic pregnancy.

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