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Tuesday, November 17, 2015

Pregnancy - The First Trimester



Pregnancy is defined as the carrying of one or more offspring, known as fetus or embryo, inside the endometrial lining of a woman. It in generally, can be divided into three trimester periods to prescribe the different stages of prenatal development.

A. The first trimester (1-12 weeks)
The first trimester is the first eight weeks of pregnancy and the 2 weeks in this trimester of pregancy is considered as the highest risk of miscarriage(3) due to natural death of embryo or fetus, probably associated to associated with increased risk: high maternal age; previous miscarriage, termination and infertility; assisted conception, etc. (4) In the period, the woman body hormonal change to prevent miscarriage, protect and nourish the fetus(5)(6), may lead to certain physical and psychological symptoms.which is unique to each pregnant woman(11), including fecal Incontinence(12)(13), especially for obese women(13)
Certain complications have been found to be associated to pregnancy loss in first trimester, including
Umbilical cord cysts(7)(8), preeclampsia(9)(10) and fetal growth restriction(9).
A.1. The journey of the baby
1. Weeks 1 and 2
You body is getting ready to prepare for the conception. Conception occurs about two weeks after your period begins. The stage of gear up to ovulation, there is no baby or even an embryo in sight(14)

2. Fertilization (week 3)
As an egg is fertilized by a sperm in one of your fallopian tubes called a zygotes. Many women are experience of weight loss due to nausea(16), vomiting(16), and loss of appetite(34), upper abdominal pain(16), caused by the hormonal changes in early pregnancy(16).

3. Implantation (week 4)
The fertilized egg is moved down to the uterus and implanted into the endonetrium. As soon as  settled in its new home, Your future baby will undergo the great divide : half (now called the embryo) will become your son or daughter, while the other half forms the placenta, your baby's lifeline  channels for nutrients and removed waste away until delivery(15)

4. The beginning of The embryonic period (week 5)(19)
At this stage, the baby's brain, spinal cord, heart and other organs start to form and the embryo is now made of three layers where the ectodermal layer will grow the central and peripheral nervous systems, skin, hair, nails, sweat glands, etc.,the mesodermal layer, will grow to muscle, cartilage, blood vessels, kidneys and spleen, and the endodermal layer, will grow to the liver, pancreas, bladder, tonsils, thryroids gastrointestinal tract and respiratory system. As the stage the limb buds can be seen, eyes are forming. and the heart has divided into right and left chambers and begins to beat, and the primary airways have developed in the lungs. Home pregnancy test of hCG hormone can confirm that you are pregnant(17)(18).

5. The neural tube closes (week 6-8)
In the 6 to 8 weeks, the the neural tube along your baby's back is closing and the baby's heart the heart has divided into right and left chambers and begins to beatand pumping blood, and the primary airways have developed in the lungs. This is a rapid growth of the stage where all basic facial features will begin to appear.The embryo is about 1 inch long and is the size of a bean(20).

6. Week 8-12 
a. Arms with tiny hands and fingers, and legs with the beginnings of knees, ankles, and toes begin to form. The baby is now moving about, although you probably won't feel this movement until about your 16th week and looks like a tiny human.
b. All baby's organs and systems have also begun to develop.
c. The head now appears very large compared to the rest of the body because the brain is growing rapidly.
d. The external genitalia is developing, but sex is still unable to determine under ultrasound.
e. Tiny ears and the beginnings of hair are forming on the head.
f. Finger and toenails are developing.
g. The mouth opens and closes and the baby will begin to move its hands, legs, and head.
h. The pituitary gland is starting to produce hormones, such as growth hormone, prolactin, corticotropin and others.
i. Weight gain for mother about 3-4 pounds
j.The brain, nerves and muscles are starting to function.
k. The palate has completely formed
l. Etc.

At the end of the first trimester, the size of the embryo is about 4 to 6 millimeters long and the mother weight gain is about 3-4 pounds.

It is necessary to mention that the embryo cord is made up of blood vessels to transport oxygen and nutrient to the baby and remove the baby's waste. The baby is moving very frequently although you will not be able to feel this yet(21).

A.2. Symptoms
1. Tender breasts
Due to the Increase of hormone production of progesterone(23), it usually would not occur until after you miss your period. Wearing a more supportive bra or a sports bra may help. Giagantomastia, a enlargement of the breasts greater than that of gravid enlargemen is a rare disorder known to occur in pregnancy(22)

2. Morning sickness(30)(31)
Morning sickness makes up 75% of pregnant women and can start as early as 2 weeks after conception due rapidly rising levels of estrogen and progesterone(24), with the symptoms are worst in the morning and ease up over the course of the day(24). In some women, the symptoms can strike at any time but for most women, they are last all day long(25). It is recommended to eat small, frequent meals throughout the day with plenty of fluids and avoid foods or smells that make your nausea worse. Untreated morning sickness, once nausea and vomiting of pregnancy progresses, it can become more difficult to control symptoms in inducing serious complications, including hospitalization(26), Acupuncture(27), acupressure(28) and herbal medicine such as  ginger, chamomile, lemon oil, mint oil(29),...can be helpful.

3. Fatigue(30)(31)
You may feel tired as your body prepares to support the pregnancy. Your heart will pump faster and harder, and your pulse will quicken. To combat fatigue, rest as much as you can. Make sure you're getting enough iron and protein. Include physical activity, such as a brisk walk, in your daily routine.

4. Increased urination
As the uterus pressing on the bladder, it causes you to go to washroom more frequent. In some women(12)(13), it causes leaking urine when sneezing, coughing or laughing.

5. Heartburn(32)(33) and indigestion(33)
The production of hormones progesterone and relaxin can cause the relaxation of the gastrointestinal linings smooth muscle, leading to slow-down of the digestive system in food digestion, causing heart burn and indigestion. Pregnancy-related heartburn predisposes to early postpartum heartburn(32)
To prevent heartburn, eat small, frequent meals and avoid fried foods, carbonated drinks, citrus fruits or juices, and spicy foods.

6. Dizziness(34)
Dizziness in first trimester is caused by blood vessels to relax and widen as a result of hornomal change in the woman body to pump more blood the fetus but the slower return of the blood to the woman vein can reduce the blood flow to the brain, causing dizziness.

7. Weight gain(32) or weight loss(35)
a. Weight loss(35)
In some women, the physical symptoms can cause certain amount of weight loss. which could lead to weight loss. A small amount of weight loss during the first trimester of pregnancy may be nothing to be worry about.
b. Weight gain(32)
Some women might experience weight gain in the first trimester, as it is the smallest amount of weight gain (around three to five pounds) will occur during the first trimester. First trimester weight gain should total right around three to five pounds.

8. Psycological change(36)
Due to hormonal change that affects you psycologically, such as
a. A new baby adds emotional stress to your life.
b. Bouts of weepiness or mood swings.
c. Etc.
To cope with these emotions, talk to your friend or counselor might be very helpful, especially if the feelings of anxiety and tension due to past feelings.

9. Etc.

A.3. What you must aware of in the first trimester to prevent miscarriage or recurrent miscarriage(1)
1. Heavy bleeding(2)
Spotting is normal, if you have heavy bleeding and bad cramping similar to period cramps and coupled with sharp lower abdominal pain, you should go to hostipal right the way as it is a sign of either miscarriage or ectopic pregnancy.

2. Excessive nausea and vomiting(37)
Excessive nausea and vomitting can lead to weight loss, dizziness, dehydration. If dehydration. occurs, you must go hospital for treatment.

3. High fever(37)
It may be sign of infection, report this to ypur doctor as soon as possible.

4. Vaginal discharge and itching(37)
It may be a sign of infection, if left untreated, it can cause problem to your baby.

5. Pre-existing medical conditions(38)(39)
Certain pre-existing medical conditions if not under well-controlled, it can have serious problem to your baby’s health.

6. Etc.

A.4. Herbs to protect your baby and enhance your baby's growth in first trimister
Please do not use these herbs until you have consult with your herbal medicine practitioner.
There is always controversy to give herbs to pregnant woman in the first trimester as the fetus has not been formed. Some herbalists suggested some herbs can be taken while many others do not. I will leave this A.4. blanks for the mothers to make their choices.

A.5. Chinese herbs protect your baby and enhance your baby's growth in first trimister
Please do not use these herbs until you have consult with your traditional Chinese medicine practitioner.
Traditional Chinese medicine has been around over 4000 years and considered as one of the best in optimization of the condition of the mother by improving the pre-existing problems and recommending the proper diets and life styles. According to The TCM classic "Qian Jin Yao Fang" ("Thousand Golden Essential Prescriptions") by Sun Simiao in the Tang Dynasty (618-907AD), the baby is not formed in this period and the pregnant woman should not take any medicine for reinforcement.

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References
(1) Oral dydrogesterone treatment during the first trimester of pregnancy: the prevention of miscarriage study (PROMIS). A double-blind, prospectively randomized, placebo-controlled, parallel group trial. by Walch K1, Hefler L, Nagele F.(PubMed)
(2) Subchorionic hemorrhage in first-trimester pregnancies: prediction of pregnancy outcome with sonography. by Bennett GL1, Bromley B, Lieberman E, Benacerraf BR.(PubMed)
(3) Miscarriage risk for asymptomatic women after a normal first-trimester prenatal visit. by Tong S1, Kaur A, Walker SP, Bryant V, Onwude JL, Permezel M.(PubMed)
(4) Risk factors for first trimester miscarriage--results from a UK-population-based case-control study. by Maconochie N1, Doyle P, Prior S, Simmons R.(PubMed)
(5) Does the thyroid-stimulating hormone measured concurrently with first trimester biochemical screening tests predict adverse pregnancy outcomes occurring after 20 weeks gestation? by Ong GS1, Hadlow NC, Brown SJ, Lim EM, Walsh JP.(PubMed)
(6) Association and predictive accuracy of high TSH serum levels in first trimester and adverse pregnancyoutcomes by Schneuer FJ1, Nassar N, Tasevski V, Morris JM, Roberts CL.(PubMed)
(7) Umbilical cord cysts in the first trimester: are they associated with pregnancy complications? by Hannaford K1, Reeves S, Wegner E.(PubMed)
(8) Clinical significance of first trimester umbilical cord cysts. by Sepulveda W1, Leible S, Ulloa A, Ivankovic M, Schnapp C.(PubMed)
(9) First-trimester uterine artery Doppler analysis in the prediction of later pregnancy complications. by Khong SL1, Kane SC2, Brennecke SP3, da Silva Costa F4.(PubMed)
(10) Evaluation of 7 serum biomarkers and uterine artery Doppler ultrasound for first-trimester prediction of preeclampsia: a systematic review. by Kuc S1, Wortelboer EJ, van Rijn BB, Franx A, Visser GH, Schielen PC.(PubMed)
(11) Physical And Emotional Changes During The First Trimester Of Pregnancy(Pregnancy blog)
(12) Prevalence of Fecal Incontinence in Women During Pregnancy: A Large Cross-Sectional Study. by Parés D1, Martinez-Franco E, Lorente N, Viguer J, Lopez-Negre JL, Mendez JR.(PubMed)
(13) Bowel habits and fecal incontinence in patients with obesity undergoing evaluation for weight loss: the importance of stool consistency. by Parés D1, Vallverdú H, Monroy G, Amigo P, Romagosa C, Toral M, Hermoso J, Saenz-de-Navarrete G.(PubMed)
(14) YOUR BABY AT WEEKS 1 AND 2(What to expect)
(15) YOUR BABY AT WEEK 4(What to expect)
(16) Exacerbation of a maternal hiatus hernia in early pregnancy presenting with symptoms of hyperemesis gravidarum: case report and review of the literature. by Schwentner L1, Wulff C, Kreienberg R, Herr D.(PubMed)
(17) The impact of LH, E2, and P level of HCG administration day on outcomes of in vitro fertilization in controlled ovarian hyperstimulation. by Wei M, Zhang XM, Gu FL, Lv F, Ji YR, Liu KF, She H, Hu R.(PubMed)
(18) Human Chorionic Gonadotropin (HCG);The Pregnancy Hormone(American pregnancy association)
(19) Your pregnancy: 5 weeks(Baby center)
(20) The First Trimester Of Pregnancy(American pregnancy association)
(21) 8 – 12 WEEKS PREGNANT(Doctor and daughter)
(22) Gigantomastia in pregnancy with an accessory axillary mass masquerading as inflammatory carcinoma. by Lokuhetty MD1, Saparamadu PA, Al-Sajee DM, Al-Ajmi R.(PubMed)
(23) Breast Tenderness(Progesterone research network)
(24) Morning sickness control in early pregnancy by Neiguan point acupressure. by de Aloysio D1, Penacchioni P.(PubMed)
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(26) Practice Bulletin Summary No. 153: Nausea and Vomiting of Pregnancy. [No authors listed] (PubMed)
(27) Acupuncture treatment of morning sickness. by Zhao CX.(PubMed)
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(33) Remedies for common family ailments: 1. Indigestion and heartburn by Sinclair A.(PubMed)
(34) Appetite sensations in pregnancy among agropastoral women in rural Tanzania. by Patil CL1.(PubMed)
(35) All About the First Trimester By Kate Neale Cooper
(36) Understanding Psychological Changes during Pregnancy by Elizabeth Eden, MD
(37) Maternal morbidity in early pregnancy in rural northern Bangladesh. by Kim JM1, Labrique A, West KP, Rashid M, Shamim AA, Ali H, Ullah B, Wu L, Massie A, Mehra S, Klemm R, Christian P.(PubMed)
(38) Pregnancy and Obstetrical Outcomes in Women Over 40 Years of Age by Dietl A1, Cupisti S2, Beckmann MW2, Schwab M3, Zollner U3.(PubMed)
(39) Herbal medicines used during the first trimester and major congenital malformations: an analysis of data from apregnancy cohort study by Chuang CH1, Doyle P, Wang JD, Chang PJ, Lai JN, Chen PC.(PubMed)

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