Pregnancy: Early Symptoms, Stages, Causes, Delivery Method

Pregnancy is defined as the gestational period, in which one or more offspring grows and develops inside the woman’s womb (uterus). The gestation period lasts for around nine months. Most of the babies are born between 38 and 42 weeks. An embryo is a term for the developing offspring during the first eight weeks following fertilization (i.e. ten weeks gestational age), after which the term foetus is used until birth.

Pregnancy in humans is a pretty complicated process that involves several steps. It happens when the male (sperm) and female (ovum/egg) gametes fertilize inside the female reproductive organ to give rise to a newborn. The following steps need to occur to become pregnant.

Sperm Transport

For a woman to get pregnant, a man's sperm (male gamete) that is produced in the testis (part of the male reproductive system) must be placed in her vagina. This can be done by the following methods:

1. Natural sexual intercourse: In this method, the man's erect penis is inserted into a woman's vagina during sex, and a fluid called semen is ejaculated from the man's penis into her vagina.
2. Assisted reproductive technology (ART): this includes the medical procedures which are primarily used when one is infertile, and the natural process of pregnancy has failed. Some of these medical procedures include:
   1. In-vitro Fertilisation (IVF)
   2. Intracytoplasmic Sperm Injection (ICSI)​​​​​​​

The transport of sperm depends on several factors:

1. The sperm must be capable of travelling through the environment of the female vagina and cervix.
2. The vaginal environment which is majorly under cyclic hormonal changes should admit the sperms without destroying them.
3. The sperm must be capable of converting to a form that can penetrate the ovum.
4. The sperm can survive in the female reproductive tract for up to five days.

Ovulation and Egg Transport

It is the process in which a mature ovum/egg (female gamete) is released from the ovary.

1. Each month inside the ovaries, a group of eggs starts to grow in small, fluid-filled sacs.
2. Eventually, one of the eggs erupts from these sacs and is picked up by the fallopian tube.
3. Transportation of the ovum/egg through the tube takes about 30 hours. Following ovulation, the ovum/egg can get fertilized for only 12 to 24 hours.

Fertilization

It is a process in which the sperm meets an ovum/egg to form a zygote (fertilized ovum). This happens in the fallopian tube. This is the point at which pregnancy begins. After fertilization, a series of events happen that include:

1. The single cell embryo called the zygote undergoes the first cell division.
2. Over the seven days, the embryo undergoes multiple cell divisions, and at the end, the embryo becomes a mass of organised cells called a blastocyst. This mass of cells begins a rapid descent to the uterus.

Implantation

It is the process in which the embryo attaches itself to the uterine wall.

1. The tissues between the growing embryo and uterine wall are known as the placenta. Placenta provides nutrition to the growing embryo until birth.  
2. Further development of the baby takes place in the uterus.
3. The normal gestation period for humans is 38 weeks which is a little over nine months.

At the end of this term, the uterine contractions begin under the influence of hormones (oxytocin hormone) that affect the cervix causing them to dilate to allow the baby to pass outside the mother's body.

Pregnant women in most cases will start seeing the symptoms from the first day of a missed period. Pregnancy symptoms can range from mild and annoying discomforts to severe.  However, the following signs and symptoms of pregnancy can be noted:

1. Absence of monthly periods
2. Headache
3. Tiredness 
4. Weight gain
5. Swollen and painful breast
6. Cramps
7. Acne, vomiting
8. Mood swings
9. Frequent food cravings
10. Increased urination
11. Fatigue
12. Constipation
13. Increased vaginal discharge

Most women are diagnosed with pregnancy after a missed period and pregnancy tests. Pregnancy tests check for the amount of a hormone called the human chorionic gonadotropin (HCG) made by the woman's placenta once the fertilized egg implants in the uterus/womb. This hormone can be checked in the urine or blood.

1. Urine Pregnancy Test: it can be done at home by a woman using a urine pregnancy test kit. The kit can be purchased over the counter from a pharmacy. This test is discreet, convenient, quick and simple to use. If a woman follows the instructions, they're accurate. Sometimes, it may also give a false-positive result. For further confirmation, one must go for a blood pregnancy test.
2. Blood Pregnancy Test: the test is done at a doctor's clinic/office. This test is more accurate when compared with the urine pregnancy test as it confirms pregnancy.

Once the woman detects her pregnancy using the pregnancy test kit, she can consult her doctor for further diagnosis. The doctor will use a multifaceted diagnostic approach to diagnose pregnancy. This approach includes 3 main diagnostic tools which are history and physical examination, laboratory evaluation, and ultrasonography. 

1. Physical Examination: missed menstrual periods, darkening of nipples, cervix, and vagina are used for early pregnancy diagnosis.
2. Blood tests: These are done at the doctor's office, although they aren't as common as urine tests. These tests can identify pregnancy six to eight days following ovulation, which is quicker than a home pregnancy test. The results take longer to come in than with a home pregnancy test.
3. Urine tests: These usually detect the pregnancy after 12-14 days of fertilization.
4. Ultrasound: For detection of any fetal abnormalities and multiple pregnancies.
5. Human chorionic gonadotropin (hCG) test: hCG levels in the body are used to diagnose pregnancy (hCG). When a woman skips a period, the hCG levels increase dramatically. A urine or blood test can be used to detect hCG.

The doctor may also ask a pregnant woman to get some other tests done during the gestation period. These tests include: 

1. Genetic carrier screening: If a woman or her spouse has a family record of genetic problems or has had a foetus or newborn with an inherited condition, the doctor may recommend a genetic diagnosis during the gestation period.
2. Amniocentesis: In this, a specimen of the amniotic fluid that rings the foetus is analyzed. It identifies chromosomal anomalies and opens neural tube anomalies like spina bifida. 
3. Chorionic Villus Sampling (CVS) test: It is a prenatal analysis that includes collecting a specimen of placental tissue from the mother. CVS, unlike amniocentesis, does not reveal the presence of open neural tube abnormalities. Females with CVS should also have a regular blood analysis between 16 and 18 weeks of gestation period to check for these abnormalities.

Fertilisation occurs subsequently when a man's sperm impregnates an egg (ovum) that has been liberated from the ovary during ovulation. Afterwards, the fertilised egg passes downwards into the uterus and is implanted. The pregnancy period varies from 38 weeks to 42 weeks and is divided into three trimesters (the three stages of pregnancy).

The First Trimester (0-13 weeks)

1. During this period, the body undergoes numerous changes including hormonal changes that affect every organ system of the pregnant woman. 
2. The baby’s body structure and organs develop.
3. The body will also undergo major changes, and the woman may feel common symptoms that include nausea, fatigue, breast tenderness and frequent urination. But every woman has her own unique experience.

The Second Trimester (14-26  weeks)

1. The second trimester is when many of the unpleasant symptoms of early pregnancy subside.
2. The woman is likely to have increased energy and sleep better. However, some women experience back or abdominal pain, leg cramps, constipation or heartburn.

The Third Trimester (27- 40 weeks)

This is the end of the pregnancy.

1. During the final trimester, the baby’s bones are fully formed, its touch receptors will be fully developed, and the baby’s organs can function independently.
2. Some of the physical symptoms that a pregnant woman may experience during this period include shortness of breath (as the foetus is developing), haemorrhoids, urinary incontinence, varicose veins, and sleeping problems. Many of these symptoms arise from the increase in the size of the uterus, which expands.
3. As a pregnant woman near her due date, the baby’s body may feel lazy, lethargic and sluggish.

The choice of delivery method depends on several factors including the pregnant woman's age, pregnancy stage, the overall health of the pregnant woman, complications and comorbidities linked with pregnancy (diabetes, injury, hypertension, HIV and other health conditions). Considering these factors, the gynaecologist may suggest one of the following pregnancy delivery methods:

1. Normal Vaginal Delivery: when a pregnant woman gives birth through her vagina. It is the most common method of childbirth. During vaginal birth, the pregnant woman's uterus contracts to thin and opens the cervix and pushes the baby out through the vagina (or birth canal). 
2. Assisted Delivery: This delivery method is undertaken when pregnancy complications occur. The assistance can vary from the use of medicines to emergency delivery procedures. The choice of the procedure by the doctor will depend on the conditions that might arise in labour. These assisted delivery procedures include:
   1. Episiotomy: a surgical incision in the perineum (the area of skin between the vagina and the anus) to enlarge the vaginal opening to allow the baby's head to pass through more easily and prevent the tearing of the mother's skin.
   2. Amniotomy: a method that involves artificial rupture of the amniotic membranes, or sac, which contains the fluid surrounding the baby. This method can be done before or during labour.
   3. Induced labour: this involves prompting the uterus to contract during pregnancy using medications. This method is most often used for pregnancies with medical problems or complications.
   4. Cesarean section: also known as c-section, is a surgical procedure performed through an incision made in the abdomen and the uterus.

Health problems may also arise before or during pregnancy, leading to complications. This can harm the mother's health, the baby's health or both. The complications of pregnancy include:

1. Miscarriage: It is the termination of pregnancy before the 20th week. It occurs in 10 to 20% of pregnancies. It mostly occurs early in pregnancy before a woman ever realizes her pregnancy.
2. Urinary Tract Infection (UTI): The uterine tract is altered due to hormonal changes in the body, making it more susceptible to infections.
3. High blood pressure (BP): Females with pre-existing or persistent high BP are at higher risk than those with normal blood pressure of experiencing pregnancy problems. However, many pregnant women with high BP have healthy babies without significant complications.
4. Gestational diabetes: pregnant females can experience high blood sugar concentrations during the gestation period, and thus it is known as gestational diabetes.
5. Iron deficiency anaemia: Anaemia is caused due to reduced iron in the body. During delivery, heavy bleeding may result in iron deficiency anaemia in females.
6. Hyperemesis gravidarum: It includes severe nausea, vomiting, weight loss, dizziness and potentially dehydration.
7. Postpartum depression: The cause can be physical, genetic, emotional as well as social factors. Some of the common symptoms include anxiety, low energy, extreme sadness and crying.
8. Obesity and weight gain: studies have shown that women who are obese before they get pregnant are at a greater risk of developing pregnancy complications.

When to see a doctor?

A woman can consult the doctor if she experiences:

1. Absence of monthly periods
2. Fatigue 
3. Cramps
4. Vomiting
5. Increased vaginal discharge
6. Tiredness

If a woman has had sex in the past few days, it isn’t too late to prevent pregnancy. There are numerous ways by which a woman can prevent pregnancy. Some of them may be more effective than others. Below mentioned are some of the methods by which a woman can prevent pregnancy. 

Barrier Methods

1. Condoms: male and female condoms are types of contraception that prevent pregnancy and protect against sexually transmitted diseases (STI). They are available without prescriptions from supermarkets, drugstores, or online.
2. Diaphragm: contraception that a woman places inside the vagina. The female must insert the diaphragm a few hours before the intercourse, leave it for six hours after the intercourse, and remove it after 24 hours.
3. Cervical Cap: a silicon cup that is placed deep inside the vagina. It covers the cervix to stop the sperm from entering the vagina.

Hormonal Methods

1. Contraceptive pills: birth control pills are one the most commonly used contraceptive methods to prevent pregnancy. There are two types of pills, combined pills that contain oestrogen and progestin and mini-pill that contains only progestin.
2. Patches: people can also use patches to prevent pregnancy. A patch must be worn for 3 weeks before removing it for 1 week to allow the menstrual period.
3. Injection: contraceptive shots can be given by doctors every 12 weeks to prevent pregnancy.
4. Vaginal ring: a small plastic ring is placed inside the vagina for 3 weeks that releases hormones into the body to prevent pregnancy.

Intrauterine Devices (IUDs) and Implants

1. IUDs: are small devices that a doctor inserts into the uterus. They are of two types, Hormonal and Copper based.
2. Implants: a matchstick-sized rod is inserted into a person's arm that releases hormones in the body.

Other Methods

1. Family Planning: it is a natural method of contraception that involves tracking of menstrual cycle and avoiding sexual intercourse.
2. Emergency Contraception: this method is undertaken in the case of unprotected sexual intercourse or failed birth control. Emergency contraceptive pills are a form of emergency contraception.
3. Sterilization: this procedure is done to reduce fertility permanently. Both men and women can undergo this procedure.

During pregnancy, a woman needs to take a lot of nutritious food items to meet the needs of the young one. The woman must include the following items in her diet to help her gain all the necessary nutrients.

1. Dairy products: The body needs extra calcium and protein for the young one. One must include dairy products like yoghurt, greek yoghurt, smoothies, parfaits, and lassi.
2. Legumes: Legumes are a great source of fibre, protein, iron, and calcium. A woman must include food items like beans, chickpeas, soybeans, lentils, and peanuts. According to doctors, a woman must take six hundred grams of folate daily.
3. Sweet potatoes: Sweet potatoes are a great source of beta carotene and vitamin A. Vitamin A is necessary for the baby’s development.
4. Salmon: If a woman eats seafood then she must include salmon in her diet. It is rich in omega-3 fatty acids and helps in the development of the brain and eyes of the baby.
5. Eggs: They are high in fat, vitamins and quality protein. Eggs are a great source of choline which is a vital nutrient needed by a pregnant lady.
6. Dark and leafy green vegetables: Vegetables like broccoli, spinach, and kale are packed with calcium, iron, folate, vitamin C, vitamin K, vitamin A, and potassium. Adding green vegetables to the diet will give a woman the necessary nutrients.
7. Lean meat and proteins: Lean meat is a good source of quality protein. Adding lean meat to the diet will help increase the amount of iron.
8. Berries: They are a good source of fibre, vitamin C, antioxidants, water, and healthy carbs.
9. Whole grain: A woman must add whole grains like oats, brown rice, quinoa, and barley to her diet. They are a good source of fibre, plant compounds and vitamins.
10. Avocados: They are rich in vitamins, potassium, copper, and fibre. Avocados are also rich in healthy fats that help in building the skin, brain, and tissues of the young ones.
11. Dry fruits: They are high in vitamins, nutrients and healthy fats. Prevent the candied varieties of dry fruits as they contain a lot of sugar.
12. Fish liver oil: Fish oil is rich in omega-3 fatty acids and DHA. It helps in the development of the eye of the baby.
13. Water: During pregnancy, the body transfers hydration from the mother to the baby, so a pregnant woman must stay hydrated. If a pregnant woman does not consume enough water, she will become dehydrated.

Lifestyle Changes during Pregnancy

It is equally important for a woman to start making changes before she gets pregnant. The below-mentioned steps will help a pregnant woman's body for pregnancy and give her a better chance of having a healthy baby.

1. Stop smoking, alcohol, drugs, and limit caffeine: intake of alcohol and smoking will make it harder for a woman to conceive and may also increase the chance of miscarriage.
2. Eat a balanced diet: a balanced diet will always be good for the pregnant woman and help her have a healthy baby. A few simple steps include:
   1. Reduce calory intake
   2. Eat food that is high in protein
   3. Fruits, vegetables, grains, and dairy products will make the woman healthier before she gets pregnant.
3. Take vitamins and folic acid: intake of essential vitamins, minerals and folic acid reduce the risk of birth defects in the baby.
4. Exercise regularly: exercising before getting pregnant will help the body deal with all the changes that a woman will undergo during and after pregnancy.
5. Stress, rest and relaxation: keeping oneself out of stress and taking a good amount of rest will make it easier for a woman to become pregnant.

Pregnancy is a huge milestone in a woman's life. Knowing what to expect during pregnancy is essential to monitor the mother's health and developing foetus. If someone wants to avoid pregnancy, then being aware of the additional effective methods of birth control is also necessary.

One can contact online health professionals of HexaHealth, which has top doctors and surgeons with the best hospitals empanelled in their network. It provides complete care services and hassle-free surgery for pregnancy at the right hospital and at an affordable price. One simple phone call with the professionals will ease all the worries, doubts and concerns.