OVERVIEW
Today the care of mother has evolved and many changes have been made by political and consumer pressure for the organization of the need to align the appropriate care to get maximum output. 4 months pregnant women demand antenatal care and it varies widely around the world. The care provided to the mother is important as it will improve the pregnancy outcomes and decrease the risk of death of the baby and mother.
DATING THE PREGNANCY
The pregnancy is dated from ancient times from the last menstrual period and not the date of conception. The total duration of pregnancy is 280 days or 40 weeks and from this ratio, we get the expected date of delivery exactly. This signifies that the cycle length of a woman is approximately 28 days and the 14th day is the day where ovulation occurs.
The expected date of delivery is calculated by taking the last month of the menstrual cycle and counting forward to 9 months and then adding 7 days. This formula is applied only when the women have a normal cycle which is straight after terminating the oral contraceptive pills and after giving the previous birth.
WHAT MAY WOMEN EXPERIENCE WHEN SHE IS 4 MONTHS PREGNANT?
Gastrointestinal tract abnormality
Women experience constipation and it results from the combination of mechanical factors and hormone factors that slow down the motility of the gut. If the iron tablets are given to 4 months pregnant lady to treat the anemia, this condition further increases the risk of women to suffer from constipation.
She should be given a diet rich in fiber, fruits, and vegetables and medications like lactose may be suggested to treat the symptoms of constipation in 4 months, pregnant lady.
Musculoskeletal symptoms
It is the common problem in pregnancy caused by pregnancy is backache which is due to laxity of spinal ligaments, additional weight gain, and due to a shift in the center of gravity when the uterus grows. The pregnancy can exacerbate the symptoms of intervertebral Disc prolapse, leading to complete mobility. Women should be taught that she should maintain correct posture, avoid heavy weight lifting, avoid high heels, get Physiotherapy on regular basics and simple analgesics like Paracetamol can help relieve the pain.
There are certain neuropathies that may occur like carpal tunnel syndrome. It occurs due to the entrapment of the median nerve where it passes through the fibrous Canal at wrist before it enters the hand. There are numerous symptoms which are women can experience like numbness, tingling and weakness of forefinger and thumb. The pain is worst at night.
Varicose veins
Varicose veins occur in the 4 months pregnant lady for the first time or the pregnancy may exacerbate pre-existing Varicose veins. It is due to the effect of progesterone on vascular smooth muscles and increased weight. This condition can be prevented by wearing support stockings avoidance of standing for long periods of time and simple analgesia.
Edema
Edema occurs in more than 80% of pregnancy due to tissue swelling and increased capillary permeability which causes the fluid to leak into the extravascular compartment. Fingers, toes and ankles are most affected.
Urinary tract infections
Urinary tract infections are common in pregnancy and more than 70% of women have asymptomatic urinary tract infection. If the urinary tract infections are untreated in 4 month pregnant lady, it my progress to renal damage.
Abdominal pain
It is one of the commonest symptoms and is rather a physiological pain then other cause of pain. if the pain is worst, X Ray and invasive assessment should be made to rule out the diagnosis for various serious conditions.
HOW SMOKING EFFECTS 4 MONTHS PREGNANT LADY?
Smoking reduces the blood transport to the Placenta which connects the mother and baby. When the mother is smoking in pregnancy, the babies born are smaller at delivery and there is a high risk of placental abruption in the women who smoke as compared to the women who do not smoke.
The perinatal mortality is increased and it is estimated that the baby born to a woman who smokes will be 15-gram times the average number of cigarettes the women smokes a day. Quitting smoking by the 15th week of gestation lessens the chances of any risk to the baby and mother.
LABORATORY EXAMINATION:
The 4 months pregnant women can confirm the pregnancy via ultrasound and examination of beta hCG. There are home-based test which includes a urine test to confirm the pregnancy. Amniotic fluid examination, fetoscope, and cardiotocographic assessment can give information about the development of the fetus.
DIETARY AND EXERCISE ADVICE:
The four month pregnant lady should be given the dietary advice to get an optimum weight gain in pregnancy. She should eat fiber-rich foods like beans, lentils, vegetables, pasta and brown rice, and meals based on starchy foods like potatoes, rice and bread should be given. Fried food, drinks, and caffeine should be avoided and she should take five portions of fruits and vegetables every day. She should be told that she should do the exercise which includes aerobic and strength conditioning as it is considered safe and beneficial and it helps to improve the recovery after delivery and reduce pelvic pain during delivery.
DELIVERY OPTIONS:
There are generally three methods for the birth of the baby and women should be given the options where she would like to deliver the baby so as to comfort her.
There are three places where the women can give birth which include
- home birth
- birth centers or midwife units
- hospital birth centers
Only 2% of the Pregnant women to deliver at home. The only advantage of home birth is the familiar surrounding, no separation from other children and women’s partners, and no fatigue of going to the hospital.
Midwife units may be isolated or attached to hospitals and the only advantage of midwife units is that the convenient locations and lesser interventions.
Most of the women like to give birth in the hospital as there is direct access to neonatologist and obstetrician. The doctors are available all the time and better care is given to the baby and mother.
