Women Pregnancy Cycle

Women Pregnancy Cycle
All pregnancies are divided into three parts (by the medical profession) . Each part is a trimester – a period of three months, or more precisely, of 13 weeks. This division is useful because various events, signs, and developments tend to appear in different trimesters.
The First Trimester

It is the first stage in pregnancy cycle. During the first three months the uterus enlarges to about three times its non-pregnant size. This places it approximately at the pelvic brim so that it is usually not palpable (perceptible by touch) in the abdomen.

Bleeding of some severity is the most frequent unusual feature of the first trimester. About 20 per cent of women will stain or have a blood smudge on their underwear for one to three days. Usually this is “implantation bleeding” as the fertilized egg nests into the uterine wall after its descent down the Fallopian tube (oviduct) where fertilization occurs. Implantation usually occurs about three weeks after the last menstrual period. At this stage the developing egg is barely visible to the naked eye, about the size of the point of a sharp pencil.

No further bleeding may occur. But if bleeding continues, with some slight cramps, there is threatened abortion with survival of the fetus in precarious balance. If cramps become severe and rhythmical, similar to labor contractions, bleeding becomes profuse, and on vaginal examination the doctor finds the neck of the uterus opening up, the condition is described as inevitable abortion. If the fetus is expelled but the placenta remains, this is an incomplete abortion. This usually requires a curettage of the uterus to remove the remaining products of conception. Thereafter bleeding is usually moderate for a day or two and then staining ensues for several more days. Usually the uterus returns to its normal size in three to four weeks and a normal menstrual cycle intervenes at about the same time.

A spontaneous abortion – or “miscarriage” – is a natural process that occurs without artificial intervention. The vast majority of such abortions probably occur as a result of a developing egg with serious defects incompatible with life, or destined to give rise to a cruelly malformed fetus. The untimely occurrence of a spontaneous abortion is infinitely less of a burden than the presence of an infant that could not live long, and this is nature’s way of ending a defective pregnancy and reestablishing the reproductive machinery for off-spring.

Sometimes the fetus dies in the womb and the womb fails to grow. This is called missed abortion, and again, a curettage may be required. An induced abortion is one in which the uterus is emptied by human intervention. A therapeutic abortion is one justified in the eyes of the law, usually because continuation of pregnancy threatens the mother’s life. Such indications are quite rare. If a woman has three or more consecutive spontaneous abortions, she is designated as an habitual aborter.

The embryo, a mere pinpoint in size at the beginning of the first trimester, grows to a length of some three inches and a weight of one ounce by the end of the third month. During this time, all of the vital organs heart, lungs, intestines, brain, eyes, ears and skeleton-are formed. It is at this crucial period, when some women do not even know that they are pregnant, that outside insults such as drugs and illnesses of the mother can inflict disaster on the fetus. Once the basic structures are well developed, the fetus is somewhat better able to fend off insults of its environment.

Ectopic pregnancy usually occurs in the first trimester. The infinitesimal embryo is trapped in the blind alley of a Fallopian tube and will grow at this ectopic (“outside of the uterus”) point. Space for growth in the narrow tube is very limited, and rupture usually ensues in the second or third month.

Symptoms of ectopic pregnancy begin when the tube is overdistended. There is severe one-sided pain, bleeding as in amiscarriage, and a small swelling in the tubal area may be felt by the doctor. Blood in the abdomen frequently reaches and irritates the diaphragm and this is felt as pain in the shoulder. Surgery to remove the portion of the tube containing the pregnancy is the only satisfactory treatment. Recovery is rapid and the patient will be walking about the hospital in one day and home in five or six.

Is normal pregnancy possible after an ectopic pregnancy? Yes, but it is not uncommon for a woman who has had one ectopic pregnancy to have another on the other side. The doctor will be alert for this possible complication if the patient has had an ectopic pregnancy.
The Second Trimester
The second trimester or the second stage of pregnancy cycle is the most peaceful time of pregnancy with the fewest complications.
Growth

From a length of three inches and a weight of one ounce, the fetus grows to some 14 inches and a weight of two and a quarter pounds at the end of the second trimester. The accommodating uterus enlarges steadily to an edge two and a half inches above the navel. Movements of the fetus (“quickening”) become noticeable at about 20 weeks or midway in the second trimester. Usually the obstetrician will be able to hear the fetal heartbeat. The mother’s weight gain is most rapid during these three months, averaging close to a pound a week.
Premature Labor

The greatest hazard of this trimester is premature labor and delivery. The patient should report immediately any continued weak contractions, vaginal staining, or thin watery vaginal discharge. Any of these may suggest that the neck of the uterus is opening and a vaginal examination will confirm or deny it.

Premature birth in the second trimester ends unhappily with death of the infant nine times out of ten. The other ten percent of larger “premies” survive after a long period of many months in an incubator. There is some hope that threatened premature birth when the infant is too tiny to survive may be delayed by a Shirodkar operation, named for a doctor in India who had a patient who had three premature deliveries ending in stillbirths. In desperation, he placed a suture around the neck of the uterus and was able to maintain the pregnancy until the infant reached a weight of five pounds and survived. Occasionally the neck of the womb is closed carefully in selected patients and the technique has been considerably improved.

Toxemia may occur in the second trimester but is much more frequent in the last three months.
The Third Trimester or third stage in Pregnancy cycle

The last months of pregnancy are naturally subject to some increase in discomfort. The infant grows from a little over two pounds to seven pounds, on the average, and the uterus gradually continues to enlarge. There is almost constant activity of the womb’s occupant, most noticeable to the hostess when she is inactive and most sensitive to internal gyrations, as when sitting, or just before going to bed, or waiting for a traffic light to change when driving.

Abnormal bleeding, again, is always something to report immediately to the doctor. There are two principal causes of such bleeding in the last trimester, and both arise from abnormalities that involve the placenta or afterbirth. Each occurs in about one out of 250 pregnancies.

Placenta previa is a mislocation of the placenta in an abnormally low position in the uterus. The placenta may be implanted directly over the outlet of the womb (central placenta previa), or it may be attached at the margin of the outlet or slightly higher on the uterine wall. As the neck of the uterus opens toward the end of pregnancy, a disruption of placental and uterine structures causes bleeding. The characteristic symptom is painless vaginal bleeding.

Bed rest in the hospital is usually compulsory. Transfusions may be necessary if bleeding is profuse, and cesarean section (delivery of the baby through the abdomen) may be required. Since every extra week of maturity counts heavily in the baby’s favor, delivery is usually delayed until about the onset of the ninth month unless there are compelling reasons to the contrary. With careful obstetrical management, the outcome is usually happy for mother and baby. Placenta previa occurs somewhat more frequently in women who have had many children, especially in rapid succession, and in women who have had fibroid tumors.

Premature separation of the placenta is responsible for the second type of abnormal bleeding. In this instance a normally implanted placenta separates from its attachment to the wall of the uterus. Vaginal bleeding is usually accompanied by severe abdominal pain. The womb may become very hard. Frequently such separations are associated with high blood pressure.

Important abdominal pain and bleeding must be reported to the doctor immediately. Management of this condition calls for discriminating obstetrical judgment. Labor may be induced forthwith, or cesarean section may be required, de­pending upon individual circumstances.

There are other causes of bleeding in the third trimester, such as polyps and inflammation, but the important thing to remember is that every instance of vaginal bleeding should be reported to your doctor immediately.

Toxemia of pregnancy is another complication which is watched for in pre­natal visits. The most frequent early sign is fluid retention, demonstrated by swelling of the fingers, tight wedding ring, swelling of the eyelids, tight shoes, and weight gain which may amount to five pounds in a week. (Some swelling of the feet at the end of the day, disappearing with rest, is common in normal pregnancies). There is abnormal protein in the urine. The more serious forms of toxemia are associated with eclampsia or convulsions.

Toxemia is an increased danger to the baby and the mother. Hospitalization for one or two weeks, and sometimes early delivery, may be necessary. Milder signs of toxemia may be controlled less drastically. A low-salt diet is important. Smoked meats, pickles, sea foods, pastries, cakes, sharp cheeses and cocktail snacks are forbidden. Long periods of rest, prolonged night sleep, and afternoon naps are helpful. Effective diuretic drugs are eminently successful in reducing fluid-swollen tissues.