Pre-Natal Care To avoid Miscarriage

A physical examination when the physician first meets the expectant mother is essential. This may pick up variations which are correctible, prevent later complications, and save the pregnant woman time in the hospital.
General Examination

The blood pressure is taken to establish a baseline level. Elevated blood pressure may presage a complication known as toxemia which usually occurs in the last three months of pregnancy. The heart is examined for function, rate and rhythm. The breasts are examined to note the pattern of the nipples, their suitability for nursing at a later date, and to determine whether cysts or tumors are present.

Laboratory examinations on this visit include complete urinalysis, a hematocrit (amount of red cells in the blood), blood grouping (A, AB, or 0), blood test to rule out syphilis and determination of the Rh factor. About 86 per cent of the population is Rh positive, 14 per cent Rh negative. If the blood is Rh negative, tests to determine the presence of antibodies will be done later.

A dentist should examine the teeth during the first three months of pregnancy. There is no real evidence of rapid destruction of teeth because of pregnancy, but frequently there is swelling and bleeding from the gum margins, which good dental treatment can minimize. There is some evidence to indicate that addition of small amounts of fluoride will be beneficial to the teeth of the developing fetus. Most of the new vitamin preparations for pregnancy have fluoride added.
Pelvic Examination

The cervix or neck of the uterus is examined and Papanicolaou smears are taken (these are cells from the cervical area, which, stained and examined under a microscope, may reveal early and curable cancer of the cervix). The position of the ovaries and tubes is noted, as well as the size of the uterus at this initial visit. The physician can determine if its rate of growth is normal during the early months of pregnancy.

Pelvic measurements may be done at the first visit, though it may be preferable to do this in the last two months of pregnancy, when the vagina is softer and larger and there is good rapport between physician and patient so the examination may be done without tension or muscular spasm. Measurements are made of the outlet between the two bones which rim the birth passage, as well as measurements made through the vagina to determine the distance across the pelvis through which the infant must pass to enter the world.
Predicting the Birth Date

As soon as pregnancy is confirmed, the patient’s first question is usually “when will the baby be born ?” The general formula is that birth occurs 280 days from the last menstrual period or 267 days from the time of last ovulation. But duration of pregnancy is highly variable, ranging from 250 to 310 days from the last men­strual period, and perhaps only one out of ten babies is born on the EDC (expected date of confinement). Frequently in a first pregnancy the baby is born a week or so beyond the expected date. Many mothers tend to repeat early or late delivery dates in subsequent preg­nancies; but there is no general rule about it and there are many exceptions.
Miscarriage

Pregnancy that termi., nates prior to the twentieth week, with a fetus weighing less than one pound, invariably incapable of life, is, in medical language, an abortion - usually called a “miscarriage” by laymen. Spontaneous abortions occur in about ten per cent of pregnancies.

Pregnancies ending between the twentieth and twenty-eighth week produce a fetus or infant weighing between one and two and a half pounds. These are called previable infants, and all will require a long period of care in a premature nursery, with a ten to 25 per cent chance of survival.

Premature infants are born between the twenty-eighth and thirty-fifth week of pregnancy. Their weights run from two and a half to five pounds. Chances of survival for the largest prematures are 80 to 90 per cent.

The term or mature infant is born between the thirty-fifth and forty-fifth week. These infants have an excellent chance of survival and almost invariably may return to the home with the mother when she is discharged from the hospital.