Pregnancy

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During the first three months of pregnancy, or the first trimester, your body undergoes many changes. As your body adjusts to the growing baby, you may have nausea, fatigue, backaches, mood swings, and stress. These things are all normal.

Most of these discomforts will go away as your pregnancy progresses. And some women might not feel any discomfort at all! If you have been pregnant before, you might feel differently this time around. Just as each woman is different, so is each pregnancy.

As your body changes, you might need to make changes to your normal, everyday routine. Here are some of the most common changes or symptoms you might experience in the first trimester:

Tiredness

Many women find they’re exhausted in the first trimester. Don’t worry, this is normal! This is your body’s way of telling you that you need more rest. After all, your body is working very hard to develop a whole new life.

For some women, the nausea of the first trimester is so severe that they become malnourished and dehydrated. These women may have a condition called hyperemesis gravidarum (HG). HG refers to women who are constantly nauseated and/or vomit several times everyday for the first 3 or 4 months of pregnant.

HG keeps pregnant women from drinking enough fluids and eating enough food to stay healthy. Many women with HG lose more than 5 percent of their pre-pregnancy weight, have nutritional problems, and have problems with the balance of electrolytes in their bodies. The persistent nausea and vomiting also makes going to work or doing other daily tasks very difficult.

Many women with HG have to be hospitalized so they can be fed fluids and nutrients through a tube in their veins. Usually, women with HG begin to feel better by the 20th week of pregnancy. But some women vomit and feel nauseated throughout all three trimesters. Visit the Hyperemesis Education and Research (HER) Foundation Web Site for more detailed information on HG.

Frequency of Urination

Running to the bathroom all the time? Early in pregnancy, the growing uterus presses on your bladder. This causes frequent urination.

See your doctor right away if you notice pain, burning, pus or blood in your urine. You might have a urinary tract infection that needs treatment.

Weight gain

During the first trimester, it is normal to gain only a small amount of weight, about one pound per month.

Changes in Your Baby

By the end of the first trimester, your baby is about three inches long and weighs about half an ounce. The eyes move closer together into their positions, and the ears also are in position. The liver is making bile, and the kidneys are secreting urine into the bladder. Even though you can’t feel your baby move yet, your baby will move inside you in response to pushing on your abdomen.

Doctors Visits

During the early months of pregnancy, regular doctor visits (prenatal care) are especially important. Become a partner with your doctor to manage your care. Keep all of your appointments — every one is important!

During the first prenatal visit, you can expect your doctor or nurse to do the following:

ask about your health history including diseases, operations, or prior pregnancies

ask about your family’s health history

do a complete physical exam

do a pelvic exam with a Pap test

order lab tests

check your blood pressure, urine, and weight

figure out your expected due date

answer your questions

Get more details on prenatal care.

1st Trimester Tests and Procedures

For special genetic or medical reasons, you may need other lab tests, like blood or urine tests, cultures for infections, or ultrasound exams in the first trimester. Your doctor will discuss them with you during your visits.

The most common tests recommended in the first trimester include:

Nuchal translucency screening (NTS)

This new type of screening can be done between 11 and 14 weeks of pregnancy. It uses an ultrasound and blood test to calculate the risk of some birth defects. Doctors use the ultrasound exam to check the thickness of the back of the fetus’ neck. They also test your blood for levels of a protein called pregnancy-associated plasma protein and a hormone called human chorionic gonadotropin (hCG). Doctors use this information to tell if the fetus has a normal or greater than normal chance of having some birth defects.

In an important recent study, NTS found 87% of cases of Down syndrome when done at 11 weeks of pregnancy. When NTS was followed by another blood test done in the second trimester ( maternal serum screening test), 95% of fetuses with Down syndrome were identified.

An ectopic pregnancy is an abnormal pregnancy that occur outside the uterus (womb). The baby can not survive.

Causes, incidence, and risk factors

An ectopic pregnancy occurs when baby starts to develop outside the womb (uterus). The most common site for an ectopic pregnancy is within a fallopian tube. However, in rare cases, ectopic pregnancies can occur in the ovary, the stomach area, and the cervix.

An ectopic pregnancy is usually caused by a condition that blocks of slows the movement of a fertilized egg through the fallopian tube to the uterus. This may be caused by a physical blockage in the tube.

Most cases are a result of scarring caused by a past infection in the fallopian tubes, surgery of the fallopian tubes, or a previous ectopic pregnancy. Up to 50% of women who have ectopic pregnancies have had inflammation of the fallopian tubes (salpingitis) or pelvic inflammatory disease (PID).

Some ectopic pregnancies can be due to birth defects of the fallopian tubes, endometriosis, complications of a ruptured appendix, or scarring caused by previous pelvic surgery. In a few cases, the cause is unknown.

Sometimes, a woman will become pregnant after having her tubes tied (tubal sterilization). The risk of an ectopic pregnancy due to this procedure may reach 60%. Women who have had successful surgery to reverse tubal sterilization in order to become pregnant also have an increased risk of ectopic pregnancy.

Taking hormones, specifically estrogen and progesterone (such as those in birth control pills), can slow the normal movement of the fertilized egg through the tubes and lead to ectopic pregnancy.

Women who have in vitro fertilization or who have an intrauterine device (IUD) using progesterone also have an increased risk of ectopic pregnancy.

The “morning after pill” (emergency contraception) has been linked to some cases of ectopic pregnancy.

Ectopic pregnancies occur from 1 in every 40 to 1 in every 100 pregnancies.

Symptoms

• Lower abdominal or pelvic pain
• Mild cramping on one side of the pelvis
• Amenorrhea (missed period)
• Abnormal vaginal bleeding (usually spotting)
• Breast tenderness
• Nausea
• Low back pain

If the area of the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include:

• Severe, sharp, and sudden pain in the lower abdominal area
• Feeling faint or actually fainting
• Referred pain to the shoulder area

Internal bleeding due to a rupture may lead to shock. This is the first symptom of nearly 20% of ectopic pregnancies.

Signs and tests

The health care provider will perform a pelvic exam, which may reveal tenderness in the pelvic area. A pregnancy test is usually positive (says you are pregnant).

Tests that may be done include:

• Hematocrit (may be normal or high)
• White blood count (may be normal or high)
• Culdocentesis (to check for blood in the pelvic/abdomen area)
• Transvaginal ultrasound or pregnancy ultrasound (shows an empty uterus)

A laparoscopy, laparotomy, or D and C may be needed to confirm the diagnosis.

An ectopic pregnancy may affect the results of a serum progesterone test.

Prevention

Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. However, a tubal pregnancy (the most common type of ectopic pregnancy) may be prevented in some cases by avoiding conditions that might scar the fallopian tubes. The following may reduce the risk of a tubal pregnancy:

• Avoiding risk factors for pelvic inflammatory disease (PID), such as multiple sexual partners, intercourse without a condom, and sexually transmitted diseases (STDs)
• Early diagnosis and treatment of STDs
• Early diagnosis and treatment of salpingitis and PID

Which form of birth control you choose depends on a number of different factors, including your health, how often you have sex, and whether or not you want children. When selecting a birth control method you want to consider four factors, effectiveness, cost, health risks, and partner involvement.

Information

Here are some birth control methods for you to consider

CONDOMS

• A condom is a thin latex or polyurethane sheath. The male condom is placed around the erect penis. The female condom is placed inside the vagina before intercourse. Semen collects inside the condom, which must be carefully removed after intercourse.
• Condoms are available in most drug and grocery stores. Some family planning clinics offer free condoms.
• Latex condoms help prevent HIV and other STDs. Polyurethane condoms may give some protection against STDs, but they are not as effective as latex ones.
• About 14 pregnancies occur over 1 year out of 100 couples using male condoms, and about 21 pregnancies occur over 1 year out of 100 couples using female condoms. They are more effective when spermicide is also used.
• Risks include irritation and allergic reactions, particularly to latex.
• Condoms are used only once.

DIAPHRAGM AND CERVICAL CAP

• A diaphragm is a flexible rubber cup that is filled with spermicidal cream or jelly.
• It is placed into the vagina over the cervix, before intercourse, to prevent sperm from reaching the uterus.
• It should be left in place for 6 to 8 hours after intercourse.
• Diaphragms must be prescribed by a woman’s health care provider, who determines the correct type and size of diaphragm for the woman.
• About 5-20 pregnancies occur over 1 year in 100 women using this method, depending on proper use.
• A similar, smaller device is called a cervical cap.
• Risks include irritation and allergic reactions to the diaphragm or spermicide, and urinary tract infection. In rare cases, toxic shock syndrome may develop in women who leave the diaphragm in too long. A cervical cap may cause an abnormal Pap test.

COMBINATION BIRTH CONTROL PILLS

• Also called oral contraceptives or just the “pill”, this method combines the hormones estrogen and progestin to prevent ovulation.
• A health care provider must prescribe birth control pills.
• The method is highly effective if the woman remembers to take her pill consistently each day.
• Women who experience unpleasant side effects on one type of pill are usually able to adjust to a different type.
• About 2 to 3 pregnancies occur over 1 year out of 100 women who never miss a pill.
• Birth control pills may cause a number of side effects including: Dizziness, irregular menstrual cycles, nausea, mood changes, and weight gain. In rare cases, they can lead to high blood pressure, blood clots, heart attack, and stroke.

• Risks include irregular bleeding, weight gain, and breast tenderness.

THREE-MONTH PILL (SEASONALE)

• In 2003, the FDA-approved an estrogen and progestin pill called Seasonale. It is taken for three straight months, followed by one week of inactive pills.
• A women gets her period about four times a year, during the 13th week of her cycle.
• Seasonale is available by prescription.
• Fewer than 2 out of 100 women per year get pregnant using this method.
• The risks are similar to other birth control pills. Some women may have more spotting between periods.
• The pills must be taken daily, preferably at the same time of day.

SKIN PATCH

• The skin patch (Ortho Evra) is placed on your shoulder, buttocks, or other convenient location. It continually releases progestin and estrogen. Like other hormone methods, a prescription is required.
• The patch provides weekly protection. A new patch is applied each week for three weeks, followed by one week without a patch.
• About 1 pregnancy occurs over 1 year out of 100 women using this method.
• Risks are similar to combined birth control pills.

EMERGENCY (”MORNING AFTER”) BIRTH CONTROL

• The “morning after” pill consists of two doses of hormone pills taken as soon as possible within 72 hours after unprotected intercourse.
• A prescription is required.
• The pill may prevent pregnancy by temporarily blocking eggs from being produced, by stopping fertilization, or keeping a fertilized egg from becoming implanted in the uterus.
• The morning after pill may be appropriate in cases of rape; having a condom break or slip off during sex; missing two or more birth control pills during a monthly cycle; and having unplanned sex.
• Risks include nausea, vomiting, abdominal pain, fatigue, and headache.

CALL YOUR HEALTH CARE PROVIDER IF:

• You would like to further information about birth control options.
• You want to start using a specific method of birth control that requires a prescription or needs to be inserted by a health care provider.
• You have had unprotected intercourse or method failure (for example, a broken condom) within the past 72 hours, and you do not want to become pregnant.