A Senior Registrar in Obstetrics and Gynecology (OBGYN) National Hospital Abuja, Nigeria. He has interest in women’s health and a passion for educating women on their obstetrics and gynecological health.
When you experience symptoms and signs of pregnancy, you can either decide to go to the hospital to have a pregnancy test done or you can do a self home pregnancy test. It is simple, reliable, cheap, easy, convenient and saves you a lot of time when it is done at home. You might have read, watched, or heard about a lot of unorthodox home pregnancy tests using various materials. You might have even used one of these methods in the past or you are already contemplating about it. Well, that is not the purpose of this article, rather, I will be discussing the scientifically proven methods of testing for pregnancy, which could be done with blood or using your urine. The self-home pregnancy test using your urine is what I will be talking about. There are different pregnancy test strips in your local drug stores to choose from however, bear in mind that the sensitivity of the various strips varies. The procedure for using these strips or test kits might slightly differ. So, do well to read the instruction that comes with the kit or strip you buy.
HOW DOES A SELF HOME PREGNANCY TEST WORK?
This test detects in your urine the presence of the pregnancy hormone called β-human chorionic gonadotrophin (β-HCG) produced by the developing placenta. As early as 20 to 21 days from your last menses the β-HCG can be detected in the blood and from 28 days from your last menses it can be detected in the urine. It levels rises to a maximum at about the 10th week of pregnancy and begins to fall from the 12th week. At about 3 to 4 weeks after delivery or pregnancy loss the level drop to normal both in the blood and urine.
HOW TO DO A HOME PREGNANCY TEST
This is done using your urine at any random time because, the β-HCG is not released in the urine more at some time of the day than at other times. However, it is proposed that the early morning urine be used because the first urine is expected to be more concentrated with the β-HCG. Based on the type of strip or kit that might be available to you, your urine sample can be introduced to the test strip or kit using either of the following;
You may have to collect your urine into a clean bowl and dip the strip for a few seconds taking care not to dip it above the area on the strip marked as ‘max’
Some kits come with a pipette to help withdraw a little quantity of urine into a chamber of the kit.
While for some kits, you just have to keep it in the direction of your urine flow to make contact with it while urinating.
HOW IS THE RESULT DISPLAYED?
The result might take some few minutes to be displayed and what is displayed also depends on the type of kit or strip used. Some test kits or strips that display result as red line might have some parts labelled ‘test or T’ and ‘control or C’, these also help in result interpretation. You can have either of the following results;
POSITIVE RESULT; might display with a single plus sign (+), two red lines (=), ‘PREGNANT’ or with a ‘YES’
NEGATIVE RESULT; will display a negative sign (-), a single red line at the ‘control’, ‘NOT PREGNANT’ or a ‘NO’
INVALID RESULT; will display nothing, a single red line at the ‘test’.
An invalid result might be because the kit is not functional or there was not enough urine contact time with the test kit. When you have an invalid result, you should repeat the test with either the same strip brand or best a different brand.
CAN YOU BE PREGNANT WITH A NEGATIVE HOME PREGNANCY TEST RESULT?
Yes, it is very possible in any of these circumstances;
A test taken too early when pregnancy is suspected and too early for β-HCG to appear in the urine.
When the concentration of β-HCG is too high beyond which the kit can detect. This is found in a disease called gestational trophoblastic disease.
When the sensitivity of the test kit is low.
CAN YOU HAVE A POSITIVE RESULT AND NOT BE PREGNANT?
Possible in the following circumstances;
The pregnancy was lost soon after implantation; this is called a chemical pregnancy.
HCG secretion from a tumour.
Fertility treatment with HCG within 2 weeks of taking the test.
A genetic disorder called familial HCG syndrome.
HAVE A POSITIVE RESULT? WHAT TO DO NEXT
Congratulations if your result is truly positive, the next thing to do is to confirm the location and viability of the pregnancy by ultrasound scan. If it is in the womb and it is viable, that is great. You will be counselled by your health provider on some lifestyle changes to protect the baby, if you did not have a preconception counselling and care clinic visit.
If it is outside the womb I am sorry to say it is not good, this is called an ectopic pregnancy. You will be adequately counselled by your health care provider of the danger at hand and the various treatment options available to you to avert it. ECTOPIC PREGNANCY IS A GYNECOLOGICAL EMERGENCY.
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Hello ladies! I hope you are all having a great day. Before I begin with what I have for you today, I will like to ask a question. Have you ever performed a breast self examination? Have your breasts been examined in the past one year? Kudos to you if your answer was yes, especially if you performed a breast self examination. Physical breasts examination involves looking and touching the breasts for the purpose of identifying any changes from its normal state. It is easier to detect a change from what it used to look or feel like if you often check your breasts.
In fact, this examination might help in early detection of breast diseases and prompt seeking of health care when the cure rate is likely high. You can do it yourself or have your health care provider do it for you. If you have not done one before because you do not know how, do not worry as I will outline a step by step guide on how to perform one for yourself.
BREAST SELF EXAMINATION
This is when you check your breast yourself for any abnormality. It is important that every female from age 19 years should be taught breast self- awareness. She should know that the breast changes in size with the stages of the menstrual cycle and might be tender. Therefore, it is important to pick a specific period to check the breast every month preferably few days after the menses. It is possible that breast self-examination might not detect some cancers in the early stage.
However, regular examination of the breasts increases the chances of detection of breast abnormalities. It important to report to your health care provider when you notice any abnormal change in your breast. Note that it is normal for one breast to be slightly bigger than the other.
STEP BY STEP GUIDE ON HOW TO PERFORM A BREAST SELF EXAMINATION
STEP 1: Pick a date preferably few days after your menses
STEP 2: Stand in front of a mirror with the breast exposed
STEP 3: Observe both breasts for any obvious change in size, shape, colour or any swelling. If you have a pendulous breast lift the breasts to look underneath it.
STEP 4: Place both hands on your waist and press down then observe the breasts again.
STEP 5: Gently lift both hands up from the position in step 4 while you observe for changes
STEP 6: Draw an imaginary box with one of the vertical lines on the right side of the breast and the other on the left. Then one of the horizontal lines below the collar bone and the other below the breast.
STEP 7: you can do this lying down, to examine the left breast, place the left hand behind your head and use the right hand to examine then, do the reverse on the right breast. Use the pads of your fingers not the tip.
STEP 8: Move your fingers downwards in a vertical direction starting from below the collar bone. Gently press down from one end of the imaginary box to the other, repeat until you cover the box. Gently squeeze the nipple for any discharge.
STEP 9: you can repeat step 7 and 8 when taking your bath as the skin is wet the fingers move freely.
STEP 10: If you notice any swelling, dimpling, puckering, nipple discharge or unusual pain please see your health care provider.
WHO SHOULD HAVE PHYSICAL BREAST EXAMINATION?
As an adjunct for screening women with risk factors for developing breast cancer in low resource settings.
The American college of obstetricians and gynaecologist recommends that females aged 19 years and above should have breast examination.
It should be part of clinical examination for all women who present to a healthcare provider, especially at any first visit to a gynaecologist with or without breast complaint. Also, including visits to preconception care clinic, family planning clinic and antenatal care booking clinic.
CLINICAL BREASTS EXAMINATION
This is carried out by a trained health care provider whenever a female comes to the hospital with any breast complaint. It can be done annually depending on a woman’s risk factors for developing breast cancer. It can also be done as part of physical examination for any woman even if her complaints have nothing to do with the breast. This is so because, some women do not check their breasts and those who do, might not be doing it properly.
It is not a common occurrence to have a woman walk into the doctor’s office for the purpose of having her breasts checked. So, doing a clinical breasts examination as part of physical examination for all women is important. The doctor might just be saving a life by merely carrying out the examination. The clinical breast examination is more elaborate than the self-examination. Other regions of the body that might be examined by the doctor depending on the findings on the breast will include the armpit, above the collar bone, the chest and abdomen.
LIMITATIONS TO CLINICAL BREASTS EXAMINATION
When consent is not given.
Provider or patient discomfort.
Fear of misinterpretation of attention to the patient’s breasts, and that is why the procedure must be explained to the patient and a chaperone should be present.
Lack of knowledge or skill with the technique.
I hope this article was useful to you. Follow me on my blog to get more articles on women’s health as they are published, especially my up- coming article on breast diseases. You can also share on social media so your friends can benefit.
The loss of menses or a missed period is often associated with pregnancy. It is important to know that a missed period might not necessarily translate to being pregnant. It might be a symptom of another medical condition.
In another article, I will address the causes of menstrual loss other than pregnancy. For the purpose of this article, I will be discussing how you will feel or the changes you might notice when your loss of menses is due to pregnancy.
The knowledge of being pregnant gives off different feelings amongst women. While some might greet it with joy and cannot wait to start their antenatal care, others might not. This article will take you through the questions your health care provider might ask you before pregnancy is suspected. Only then will you be tested to confirm the suspicion of pregnancy.
WHAT TO LOOK OUT FOR TO SUSPECT PREGNANCY
Before I go into the symptoms and signs of early pregnancy, I will like you to know that pregnancy is divided into 3 phases of 3 months each called trimester. Some of the feelings you will experience and signs you will observe in the first trimester will persist into the third trimester. You will also experience some symptoms different from the earlier ones as the pregnancy progresses. What to look out for to suspect pregnancy are as follows;
TIREDNESS; extreme tiredness is one of the early symptoms of pregnancy and it resolves with time.
MISSED PERIOD; The womb every month, prepares for pregnancy, if it does not occur, it sheds its upper layer. This is responsible for the blood you see through your vagina every month. The womb weeps monthly in frustration for not meeting its objective.
VOMITING; You may start feeling like you want to vomit with increase in saliva production or even start vomiting. This is more common in the morning and often referred to as “morning sickness”. It is caused by a pregnancy hormone called human chorionic gonadotrophin and it usually resolves in the second trimester of pregnancy. It is also important to note that excessive vomiting might be a symptom of another disease complicating the pregnancy. You should see your health care provider when it becomes excessive.
BREAST CHANGES; Your breast will become tender, increase in size and in the second trimester of pregnancy start secreting breast milk.
TEMPERATURE CHANGE; You must have noticed that you feel a little warmer than you used to at some point in your menstrual cycle. This is due to the effect of the pregnancy hormone called progesterone. This usually resolves with your menses but persists when you miss your period which is suggestive of pregnancy.
INCREASED VAGINAL DISCAHRGE; This is usually white and does not have an unpleasant smell. However, you should seek health care when this vaginal discharge is associated with fever, pain on urinating, itching, unpleasant smell and change in color as these are signs of infection and can cause you problems in the pregnancy.
SPOTTING OF BLOOD VIA THE VAGINA; Some women might spot blood just about the time they are expecting their menses. This happens when fertilized egg developing into a baby gets implanted in the womb. This is of shorter duration and smaller volume compare to your normal menstrual flow.
Other symptoms might include diarrhoea, bloating, lower abdominal cramps, moody, food craving. For some women, there is no distinction between what they feel before they see their menses and some of the early symptoms of pregnancy.
You do not need to have all the above symptoms to suspect pregnancy. A missed period with either one or two of the above symptoms should qualify you for a confirmation test.
HOW TO CONFIRM YOUR PREGNANCY.
Pregnancy confirmation depends on the age of the pregnancy. What will confirm a pregnancy in the third trimester will not confirm it in the early first trimester. Pregnancy test and ultrasound scan are the most common means of confirming a pregnancy. The pregnancy test can be done with your urine or blood in the hospital. You can also have a home pregnancy test with a test kit using your urine. The diagnosis of pregnancy is made when there is a missed period with a positive pregnancy. Ultrasound scan confirmation of pregnancy is far superior to a pregnancy test. This is why your health care provider will request for an ultrasound scan after your pregnancy test is positive. Apart from confirming a pregnancy, ultrasound scan will reveal if the pregnancy is in the womb where it is supposed to be and not outside the womb, a condition called ectopic pregnancy. It can also reveal if it is a single baby or more than one babies in the womb. Also, it can reveal if the pregnancy is viable or not. Other ways your healthcare provider can confirm your pregnancy is by examining your belly to feel for your womb and also listen to the baby’s heart beat in the womb using an instrument.
HOW OLD IS MY PREGNANCY?
This is usually the next question that follows after confirming a pregnancy. The age of the pregnancy expressed in weeks called the gestational age (GA) can be estimated from the following;
LAST MENSTRUAL PERIOD(LMP); it is cheap, it uses the date you saw your last menses starting from the first day to calculate the age of your pregnancy and the expected date of delivery (EDD). There are several online calculators to help you with this. You can also use your calendar to check how many weeks old your pregnancy is from the date of your last menses. To calculate your EDD; add 7 to the day and 9 to the month if your LMP falls within the first 3 calendar months or add 7 to the day, subtract 3 from the month and add 1 to the year if your LMP is within the fourth month and above. This is sometimes a challenge as some women cannot remember the exact date they last saw their menses. In this case, the ultrasound scan becomes very useful.
ULTRASOUND SCAN; highly recommended for estimating the age of the pregnancy especially when done in the first trimester. It has other advantages which has already been mentioned above.
HEIGHT OF THE WOMB; your health care provider can measure the height of your womb from the uppermost point of the womb to the top of the pubic bone called the “symphysiofundal height”. It is measured in centimeters using a tape rule and after 20 weeks the height of the womb measured in centimeters corresponds to the gestational age in weeks. You will have this measurement checked anytime you go for antenatal care, it can also be used as an estimate to know if the baby is growing well.
MOVEMENT OF THE BABY; the period when you start feeling the movement of your baby is called “quickening”. It occurs at about 18 to 20 weeks in first time pregnancies and 14 to 18 weeks in subsequent pregnancies. This can be used to estimate the age of the pregnancy though not very accurate.
Hello ladies, good to have you read the second part of my article on preconception care; what you should know before pregnancy and what you should do before pregnancy. It promises to be a good read. In case you have not read the first part, you can read it here; preconception care.
While waiting to have the long awaited appointment with your health care provider to discuss your intention to have a baby and allay your anxiety. I will be discussing the advice and care you should know and have before getting pregnant within this article. This advice and care is called preconception counselling and care. Even after your appointment with your health care provider, you may forget some information. You can use this article as a source of revision when you need to.
The primary objective of preconception counselling and care is to ensure you are in a state of good health before getting pregnant. Note that this clinic visit is for the couple and not just for the woman.
During your first visit a detailed history will be taken from the couple starting from the bio-data mostly interested in your age, occupation and religion. Your healthcare provider will want to know if you have any complaints, your menstrual history, history of previous deliveries if any, past medical history including operations done. Your health care provider will also want to know if you are taking any medication currently, your vaccinations and if you have any bad reaction to any drug, food or animal. He/she will also be interested to know if there is any family history of an inheritable disease condition and will also want to know if you take alcohol or tobacco.
Furthermore, the woman will have a physical examination including height, weight, blood pressure, pulse, respiration and temperature measurements. A clinical breasts examination, the chest, heart, abdomen and the vagina will be examined. From the history and examination, your health care provider will tell you if you are in a state of good health or order some tests to properly advise you. The areas to be covered during this visit will depend on if you have any complaint or underlying disease condition or not. This has been covered by the various headings within.
COMPONENTS OF WHAT YOU SHOULD KNOW BEFORE PREGNANCY.
Your body mass index (BMI) calculated by dividing your weight(kg) by the square of your height(m) should be between 18.5 to 24.9kg/m2 which is the optimum. Less than 18.5kg/m2 is associated with premature breaking of baby’s water, premature labour. Women who are overweight with BMI 25 to 29.9kg/m2 or obese with BMI ≥30kg/m2 are advised to lose weight before pregnancy because they are at risk of developing diabetes, heart problems and hypertension in pregnancy. Also they are prone to having big babies, difficult delivery and more operation for delivery.
It is perfectly ok to have sex while pregnant, this will not harm the baby in the womb. Sex can only be withdrawn if (1) the pregnancy is threatening to abort, (2) if later in pregnancy the placenta is found low, covering the opening into the womb, (3) advanced pregnancy is causing discomfort to the woman. Your health care provider will tell you if need be to withhold sex during the course of your antenatal visit.
Exercise is good for pregnancy but has to be limited to only moderate exercise such as safe walk, swimming, stationary cycling. Avoid weight lighting, contact sport that can traumatise the abdomen.
Alcohol should be avoided if possible especially in the first 3 months of pregnancy. If you must take alcohol, it should be limited to one or two units per week as recommended by the National Institute for health and care excellence(NICE). Heavy drinking of alcohol should be avoided as it not only reduces the woman’s fertility it can also cause miscarriage, restrict the growth of the baby in the womb, after birth it can delay development and cause difficulty in learning.
Smoking should be stopped as it is a risk factor for a lot of pregnancy complications like miscarriage, bleeding problem, premature delivery, low birth weight, malformation, death of baby in the womb or suddenly after delivery.
Adequate nutrition is advised, eat food rich in carbohydrate such as rice, potatoes, pasta, ‘fufu’, yam, ‘garri’. Protein rich foods like beans, meat, fish, egg, dairy products like pasteurised milk, yoghurt, processed cheese. Use cooking oil, eat fruits and vegetables, drink enough water. If you are a vegetarian, you might be referred to a dietician for dietary advice.
FOOD TO AVOID
Caffeine intake should be reduced to 200mg daily or less (about 2cups of coffee). Avoid uncooked or under cooked meat, avoid unpasteurised milk, soft cheese, avoid mashed meat or vegetables as you can be infected by a bacterial that can cause miscarriage or a protozoan that cause deformity of the baby’s brain and spinal cord. Avoid eating shark and swordfish they contain heavy metals not good for the baby’s brain and spinal cord development.
You will be commenced on folic acid supplementation either low dose or high dose. Those who might benefit from high dose folic acid include; women with personal, family history or previous delivery of a baby with neural tube defect, sickle cell disease, diabetes or obesity. Depending on the part of the world you are, vitamin D might be added, especially places with poor exposure to the sun, women with obesity, previous birth of a child with fracture at delivery, rickets or vitamin D deficiency.
This is when you have lost 2 or more consecutive pregnancies. You will be advised to withhold getting pregnant until you are properly tested to find out the cause and treated. If the losses have been in the second 3 months of the pregnancy, you will be advised to have a cerclage inserted (tying of the cervix) or a drug will be given to help maintain subsequent pregnancies.
This is when the blood sugar is above the normal limit because the body is lacking or insensitive to a hormone called insulin which is necessary for uptake of available blood sugar. A woman with a family history of this disease who is not diabetic can develop it while pregnant; a condition called gestational diabetes which usually resolves after delivery. A woman who had gestational diabetes can develop it in subsequent pregnancies. One who is diabetic already will be tested to check the level of the blood sugar and how effective the medication use is controlling it. If the level of control is very poor from the test results, you might be advised to withhold plans to get pregnant. Your medication might be changed if you are on medications that can negatively affect the development of the baby to safer alternatives. You might be co-managed with the diabetologists or an endocrinologist during pregnancy. Controlling blood sugar during pregnancy might be a challenge because some pregnancy hormones increase the blood sugar in the mother to make it available for the baby. Poor control can result in pregnancy loss, abnormal growth or death in the womb, babies born with malformation, big baby with difficult delivery and the mother is at risk of developing hypertension in pregnancy.
This is when blood pressure is elevated and remains at or above 140/90mmhg taken on two different occasions at least 4 hours apart. Medications that might affect the baby will be changed to safer and effective ones. Medications in the class of ACE inhibitors like Lisinopril, ARB antagonists like valsartan will be changed because they are not good for the baby. You will be tested to check the function of your kidneys as hypertension can cause kidney problems. Hypertension can complicate pregnancy and result in early delivery.
Women with infection in the kidney or any part of the urinary system are tested and treated with antibiotics. This infection can cause pregnancy loss or premature delivery. Women with severe impairment of their kidney function may achieve good pregnancy outcome but at about 50% risk of permanent kidney damage.
SICKLE CELL DISEASE
The crisis can become more frequent with pregnancy. They could develop problems with blood supply to the baby from the placenta which could reduce the growth of the baby or even cause sudden death of the baby in the womb at any time. The woman is at risk of developing pregnancy induced hypertension. Some medications will be stopped such as deferoxamine and hydroxyurea. During pregnancy the hematologist will be part of your managing team. With proper management, most sickle cell patients will have a good pregnancy outcome.
Could be epilepsy or any other seizure disorder, the frequency of seizure is likely to increase and the dose of your medication might be increased. Some medications might be change. The neurologist will be part of your managing team.
Women with preexisting heart diseases will be investigated with the help of the cardiologist. Mild diseases might have a good pregnancy outcome. There are some types of heart diseases that pregnancy will not be recommended until after treatment. Normal pregnancy has been found to have some effect on the heart which might result in heart disease later in life. That is why women who have had babies are more at risk of developing heart disease than women who never had a baby.
Women with cancer are advised to withhold pregnancy until after treatment because, some of the treatment modalities could use radiation or medications which are not good for the developing baby. Getting pregnant and withholding cancer treatment can result in advancement of the cancer, as well as early planned delivery so that the mother can start treatment or she could die.
EMPLOYMENT RIGHTS IN PREGNANCY
The labor laws on maternal right in pregnancy has slight variation in different countries. In general, you should not be fired, refused employment, demoted or treated differently because you are pregnant.
Also, it is your right to have a safe job; when your work environment is not safe for you or the baby, your employer should make adjustments. For instance, if you work where you are likely to be expose to radiation, then you need to be reassigned. If your desk can no longer accommodate you because of the baby bump, your employer should make adjustments. If your work involves standing, you should be permitted to sit.
Furthermore, parental leave such as; maternity, paternity or adoption leave varies between countries. The United states of America family and medical leave act of 1993 protect legal parent to go on unpaid maternity leave for up to 12 weeks. The 54 counties in Africa have maternity leave which ranges from 50% to 100% pay with varied duration. In Nigeria, the labor law of 2004 grants maternity leave with full pay for 12 weeks and does not give paternity leave.
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It’s very important for a woman to be in a state of optimum health before attempting to get pregnant. Preconception care is an integral part of health care to prepare optimally for pregnancy. A great number of pregnancies are unplanned and if so, essential health interventions provided once a woman and her partner decide to have a child may be too late. If you have had a concern to worry because you do not know what to do and where to get information on this topic then, worry no more because this article is for you.
WHO IS ELIGIBLE FOR PRECONCEPTION CARE?
Couples who decide they are ready to have a baby. All females of reproductive age (15 to 49 years according to the world health organization) with pre-existing medical conditions that are severe.
WHEN SHOULD PRECONCEPTION CARE BEGIN?
Ideally Preconception care should begin 3 to 6 months before attempting conception. With the knowledge that most pregnancies are unplanned and some individuals might have some pre-existing medical conditions, the intended pregnancy might not be recommended. It is best that preconception counselling which is a part of preconception care be carried out when the opportunity presents.
WHO SHOULD PROVIDE PRECONCEPTION CARE?
It should be provided by healthcare professionals with skills on Preconception care. This can be carried out by the following groups of health professionals such as; midwives, reproductive health nurses, general practitioners, diabetologists, neurologists, cardiologists but not limited to them. This is important because patients with health needs necessitating their visit to these health professionals should know if their conditions or the drugs they are taking can impact on the pregnancy and if the intended pregnancy can impact on their health conditions and worsen it. If these health professionals are not up-to-date on Preconception counselling and care, the obstetrician or gynecologist will be the ideal person they should refer you to.
WHAT ARE THE BENEFITS OF PRECONCEPTION CARE?
It helps to identify couples with inheritable genetic disorders who will benefit from a referral to a geneticist and prenatal diagnosis.
Women with systemic diseases such as heart, kidney, severe lungs diseases can be identified and advised to postpone pregnancy until their conditions improve.
Women with bad obstetric history such as recurrent miscarriage, death of the baby in the womb, will be investigated and followed up closely to prevent recurrence.
Women with endocrine disorders like diabetes or thyroid disease will be identified and optimised before pregnancy.
The couple will be counselled on lifestyle modifications for the woman as well as diet, exercise and partner’s support.
In my next post on this, I will share more on the types of food to eat and what not to eat, suppliments to take, drugs to avoid, and your employment rights as a woman as regards pregnancy.
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