MEDICAL CARE: INTERNAL CHANGES DURING PREGNANCY. LIFE-SUPPORT SYSTEM

Due to hormonal changes, most women have their sexual desires markedly augmented so that the zenith coincides with the moment of ovulation or soon after. So it is not all apparent chance and luck. It is really by very cleverly devised means that it occurs so frequently this way.

As soon as conception occurs, and the chromosomal count is reconstituted back to forty-six (including the XX or XY ones giving the individual his sex characteristic), the cell commences to divide and divide again. All this time it is gradually propelled down the length of the Fallopian tube by gentle muscular movement aided by pulsations from the “cilia,” little hair like projections that protrude from the cells lining the tube. These set up sweeping waves that help carry the egg towards the cavity of the womb.

By the time the egg has reached the womb, the lining is quite ready to accept it. Very quickly the egg becomes embedded in the endometrial layers, usually at the upper part of the womb, either toward the front or back. Very occasionally it becomes embedded low down near the uterine outlet. But this can lead to problems at a later stage, and more has been told of this in relation to a condition called placenta praevia, in another chapter.

By now the egg has become a solid mass of cells called a morula. Under the influence of hormones from the corpus luteum of the ovary, small projections called villi grow from the outer surface of the egg. These help it become embedded even more intimately. Very rapidly, in fact, in a matter of days—the junction between the uterine wall and the egg develops into a powerful organ which is to become the placenta, and finally the ‘ ‘after-birth” at the time of baby’s birth.

Life-support System

This is the organ through which the developing baby will come into very close contact with the mother’s blood supply. In fact, this becomes its supply channel, for food, oxygen, vitamins and all other nutritional supplies. It also becomes the developing infant’s method of disposing of its own waste products.

At no time does the mother’s blood actually come into contact with that of the baby. The two are completely separate, but they are separated only by a very fine barrier. Through this barrier diffuse both ways, foods and waste products. It is an amazing exchange system, but a very workable and practical one.

The fertilized egg quickly develops. The placenta forms and the rest of the womb fills with fluid called liquor amnii, or amniotic fluid. The baby is known as an embryo in the early stages, and as it further develops it is called a foetus (which is sometimes also spelled fetus).

Besides being the exchange site for food and oxygen, the placenta is also a powerful factory. It produces chemicals called hormones which are vital to the safe development of the baby. An important one is called “H.C.G.,” short for human chorionic gonadotrophin. After a few weeks this production becomes high, so much so that excessive amounts circulate in the blood and are excreted by the mother in her urine.

This forms the basis of the pregnancy tests which are often used to prove or disprove the presence of pregnancy in a woman who is unsure. Using a special technique called radio immunoassay, or a simpler “immunological test” on the urine, the hormone’s presence can quickly be determined. It means the doctor is taking advantage of a naturally occurring situation when he has this test carried out.

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FAMILY MEDICAL CARE: LEGAL TERMINATIONS OF PREGNANCY

The net result is a rapidly increasing rate of legal terminations. Indeed, some doctors believe the interpretations have made it all too easy. But the proponents claim that these enlightened measures have almost entirely removed criminal abortions, and these were the areas that produced so many medical problems in years past.

So, whether it is for better or for worse, there seems little doubt that the new attitude to legal terminations will be here, and in most Western countries, for a long time to come.

Although some will use it in its widest interpretation and allow cases of a questionable nature to receive treatment in this manner, many other doctors will tend to stick to what they believe is right. They will recommend legal termination when it truly means that the total health and welfare of the lives- at stake are seriously involved.

At least, as the proponents claim, it has largely reduced (and in many countries completely eliminated) the amateur, and the backyard, illegal operator from the scene. Enormous numbers of women (claimed to be 10 to 15 per cent of all pregnancies in Western lands) ended up having illegal (criminal or “induced”) abortions carried out.

The circumstances were often anything but ideal. Hygiene and sterility were often lacking, and in some cases non-existent.

Actions were often rushed, and the operator was often quite unsuited and inadequately trained for the operation. Many cases of bungling inefficiency are on record. Many patients became infected and deaths occurred on numerous occasions. Some women had to be subsequently admitted to hospital for a “clean up” operation, and treatment of their sepsis (infection).

At least, under the new system, terminations are carried out in properly equipped hospital operating theatres, complete with all facilities to meet any eventuality. The surgeons are trained gynaecologists, quite expert with their duties.

There are certain medical indications for the need for therapeutic abortion (or legal termination). Carried out in its rightful place, this can be of major assistance to a mother in need. However, before any mother rushes into an abortion clinic to have the baby destroyed (and that is what it actually is) please think of the moral issues involved. The foetus you destroy is actually a living being. Though small, it is a perfectly formed human being. Is it right that you should take the life of this human being simply because it is inconvenient for you to give birth to it? Have you the right to say whether it shall live or die merely because its presence might curtail your social life, strain your budget, interfere with your career or embarrass you by its presence? You have no moral right to decide whether this unborn child shall live or die. If you make the wrong choice, you will never be free of the guilt pangs which people with consciences know when they choose abortion as an “easy way out.”

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MEDICAL CARE OF PREGNANT WOMEN: DAILY REQUIREMENTS

The recommended “Daily Allowance” of nutrients for the average pregnant woman (from the twentieth week on).

Kilojoules 10,500 (2,500 Calories)

Thiamine 1.0 mg

Protein 65 g

Riboflavin 1.5 mg

Calcium 1,000 mgm

Nicotinic Acid 15.0 mg

Iron 15 mg

Ascorbic Acid 50.0 mg

Vitamin A 6,000 u

Folic Acid 1.0 mg

Vitamin D 4,000 u

This may all sound a bit theoretical. But, when this is translated into understandable words, it simply means that the following foods should be included in the diet each day:

One pint (.6 litres) of fresh milk. (This may be taken raw, or made up in drinks, puddings, custards, or in the form of cheese.)

60 g (2 oz) of fish or meat (or protein substitute) and one egg daily.

One orange, one apple or a slice of pawpaw (papaya).

Green, leafy vegetables at least three times a week.

Apart from this simple routine, she may eat whatever she likes! However, a careful watch must be kept on the weight, for this is important during pregnancy. Sudden weight increases can lead to a serious complication in pregnancy called pre-eclampsia.

The majority of women will also benefit from the regular intake of an iron tablet daily. The actual amount will vary according to the results of the blood tests arranged by the doctor at your early visit to him.

Some women who live under poor social and economic circumstances, and women in the less affluent, developing countries may require additional vitamin and mineral needs if their diet is deficient. Such people would benefit from an iron tablet three times a day, and a vitamin tablet containing ascorbic acid 50 mg, folic acid 1 mg, thiamine 2 mg, riboflavin 2 mg, and nicotinic acid 15 mg.

Vitamin Names. Many women become confused at the seeming profusion of vitamin names. The most commonly talked about group of vitamins are those composing the “Vitamin  Complex.” This consists of a series of components, and there are several synonyms.

Vitamin B1 is also known as Aneurin or Thiamin.

Vitamin B2 is also known as Riboflavin.

Vitamin B6 is also known as Pyridoxin.

Nicotinamide and Pantothenic acid belong to the complex also.

Vitamin B12 is also known as Cyanocobalamin.

The other commonly used multiple name vitamin is Vitamin C, which is also known as Ascorbic acid.

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FAMILY MEDICAL CARE: X-RAYS FOR PREGNANT WOMEN

Thirty years ago, it was almost routine for pregnant women to have a radiological procedure called “pelvimetry” carried out.

This was aimed at measuring the bony outlet of the pelvis, and assessing if there was adequate room for the baby to pass freely through during labour and the delivery.

However, in recent years, the full force of the power of X-rays on rapidly dividing foetal cells has become more apparent.

Radiation damage and the possible development of genetic mutants is universally recognized. Therefore, the wild enthusiasm for radiography has come to an abrupt full-stop during pregnancy.

Now, every effort is made to protect women hospitals, X-rays of the pelvis or abdominal areas will be carried out only when it is known for certain that pregnancy does not exist.

Considerable efforts are made to this end. In some instances, X-rays during pregnancy may be essential. Under these circumstances, special precautions are available for the mother and infant who are at special risk. The practical application of this lies in a pregnant woman inadvertently subjecting herself to X-ray doses without thought.

In many areas, mass radiography is still carried out. It is wise to consider this if you are invited to attend for these purposes, or to embark on any mass screening system. As one obstetrics expert recently wrote: ”No female who might be pregnant should ever undergo any pelvic radiological investigation in the second half of the menstrual cycle.”

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VIRUS INFECTIONS DURING PREGNANCY: TREATMENT OF MATERNAL RUBELLA

Offering a woman a legal termination of the pregnancy may solve the short-term problem. But on the wider horizon, much can now be done for women in general.

The ready availability of rubella vaccination has changed the entire picture. The most satisfactory form of protection is for a girl to have an attack of rubella during childhood. This gives excellent protection from subsequent attacks. In many countries school-children in the age group when pregnancy is least likely are now offered rubella vaccination. This confers excellent immunity. It is by no means 100 per cent effective (as was originally believed), but it is certainly far better than no protection at all.

Older women who have not been vaccinated may receive vaccination provided pregnancy does not occur within the following three (or preferably four) months. With the universal availability of contraceptive methods these days, this is usually not difficult. If by some misfortune conception does occur within the three-month limit, then the foetus runs a certain risk, but it is much less. In 1981, a check on 100 pregnant women in America who were vaccinated during the first three months, showed no congenital defects at all. Officially the risk for defects is between 0 and 5 per cent. This contrasts sharply with between 20 and 25 per cent in completely non-immunized women who developed rubella in the first three-to-four months of pregnancy.

Because many women are completely unaware whether they have contracted rubella or not during their younger life, a specific test to check on this is available. It is known as the H.A.I, test, short for Haem-agglutination Inhibition test, and is readily and accurately carried out by pathological laboratories. It measures the body’s level of rubella “antibodies,” specific elements that confer protection. So, if there is a high level of antibodies, then the woman is fairly safe from subsequent attack.

If the infection occurs during pregnancy, and there is doubt about her antibody state, a check with the H.A.I, test may be made at once. It is then repeated two to three weeks later. If there is a sudden subsequent rise in “titre,” then it is presumptive evidence that rubella infection has occurred, and the risks can be outlined to the patient, and the correct advice offered to her.

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