Antenatal Care - Routine Care for the Healthy Pregnancy.

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Antenatal Care


The First Trimester

Baby's Development

Weeks 1 - 6

After the embryo has implanted in the lining of your womb, the foetal brain, lungs, central nervous and intestinal systems, start to form. By the end of week six, the embryo measures about 4 MM and the heart starts to beat. At this juncture, an ultrasound scan through the vagina can detect the heart beat and confirm that the pregnancy is in the right location. The fetus is too small to be seen clearly by the abdominal scan at this stage.

embryo images day by day

Tests Ordered

The doctor counts in terms of weeks, not months. The "standard" is 40 weeks though babies are considered full term once they reach 37 weeks

Weeks 6 - 9

Blood Tests

  • Full blood count
  • VDRL test - screening of syphilis
  • Hepatitis B antigen screening
  • HIV antibody screening
  • HCV antibody screening
  • Blood grouping and typing
  • Fasting blood sugar
  • TSH
Urine Routine Examiation

Ultrasound

The dating scan to ascertain the baby's heart beat and confirm the estimated due date

picture of baby at 6 week

Weeks 7 - 13

The head is growning to accomodate the enlarging brain

Eyelids are present in the shape of folds. By the end of week 12, they will meet and fuse, remaining closed until the end of week 24

External sex organs are well diferentiated by week 12

Limbs continue to develo and nails appear on the digits. The moving limbs can be "seen" on a scan but movements cannot be felt yet.

The fetus will go through rapid growth. By week 12, most of the major organ systems would have developed and the fetus measures about 6 CM from head to the buttock. The folloing changes are observed:

7 week old fetus ultrasound pictures

Weeks 11 - 13

Combined Test For Down Syndrome Screening
Blood Test:

Mother's blood is measured for PAPP-A and hcG

Ultrasound:

For nuchal translucency(NT) measurement which measures the thickness of the fluid filled area at the back of the baby's neck. Nasal bone (NB) presence or absence is also noted

11 week fetus pictures
Common Symptoms and Complaints

Nausea & Vomiting

Cause

Hormonal changes during pregnancy which differs from person to person in severity

Tips

  • Eat small frequent meals.
  • Avoid oily and spicy foods.
  • Make sure to drink adequate fluids – water, juice, soups, tender coconut etc. at regular intervals even if you are unable to eat solids.
  • Eat nutritious dry snacks like toast and crackers.
  • Take anti emetics prescribed by the doctor if vomiting is severe as these will not cause any problems in the baby.

Shortness of Breath

Due to hormone changes, you may need to take deep breaths and may become more aware of your breathing.

Giddiness

Cause

Due to hormonal changes in pregnancy, dizzy spells may occur when brain is not getting enough blood and therefore enough oxygen.

Tips

  • Get up slowly after sitting or lying down.
  • Sit down or lie down on your side when you feel faint to avoid falls.
  • As it is commonly associated with hypotension (or decrease in B.P) take plenty of fluids and include salt.

Bleeding Gums

Cause

Hormone changes may lead to swollen, tender and bleeding gums when you brush your teeth.

Tips

  • Practice good oral hygiene
  • Brush twice daily
  • Floss everyday
  • Regular dental visits
common dental problems during pregnancy

Abdominal Pain

Cause

Mild supra pubic pain is a common complaint and may be due to ‘growing’ pains as the uterus enlarges

Tips

  • Drink plenty of fluids in order to avoid urinary tract infections
  • Consult the doctor if severe or associated with bleeding
lower abdominal pain in pregnancy third trimester



CALL THE DOC!!!

  • Vaginal Bleeding: May be a sign of threatened miscarriage
  • Severe abdominal pain
  • Severe vomiting – if you are not able to retain liquids also as this can lead to dehydration and acidosis
reasons to call doctor during pregnancy

The Second Trimester

What happens in the baby

Weeks 13 - 16

You may be able to tell the baby's gender. His/Her limbs are now fully developed and can move vigorously

Weeks 17 - 24

Hair on the head develops while fine hairs on the body (lanugo) appear

Weeks 25 - 28

After 24 weeks, the baby is considered to be potentially viable. A baby delivered prematurely beyond 28 weeks has a fairly good chance of survival. By the end of the 28 weeks, the baby should weigh about 1.2 KG

second trimester fetus pictures

Tests Done

Scan

Detailed ultrasound scan (TIFFA Scan) - Between 18-22 weeks to ensure baby is growing well and there are no major physical defects

Blood Investigations

  • Hb%
  • Glucose Tolerance Test
  • Urine Routine Examination
Common Symptoms & Complaints

Quickening

Sensation of fluttery movements inside your tummy as you feel the baby move for the first time, before progressing to kicks usually appreciated anywhere between 18-24 weeks of pregnancy.

fetal movements

Backache

Cause

Strain on your back caused by the growing belly

Tips

  • Wear comfortable shoes, avoid high heels
  • Proper straight posture when sitting or standing
  • Avoid bending your back and lifting weights
  • Gentle back rubs with oil or hot water bags to the area may help

Constipation

Cause

Progesterone hormone slows down the digestive system and movement of intestines. Iron Supplements may Worsen it.

Tips

Drink plenty of fluids. Eat high fibre foods like whole grain breads, cereals, fruits and vegetables

Itchy Skin

Cause

Growing belly stretching the skin over the abdomen

Tips

  • Avoid very hot showers as it will lead to drier skin
  • Keep the skin moisturized properly
itchy skin patches during pregnancy


Leg Cramps

Cause

Cramps, may be due to the increasing weight of the baby, affecting circulation in the legs

Tips

  • Ensure adequate intake of calcium
  • During cramps, straighten legs and point toes towards face or try walking around on your heels for few minutes
  • Gentle stretching exercises
leg cramps in pregnancy remedies


Stretch Marks

Cause

Side effect of pregnancy, raised red lines on tummy, thighs, breasts and buttocks due to weight gain

Tips

Keep skin well moisturised, Avoid rapid weight gain, by eating well balanced diet

home remedies to heal stretch marks


Swollen Hands or Feet

Cause

Water Retention

Tips

  • Rotate ankles and flex your calf muscles to improve circulation
  • Stretch out your legs when sitting
  • Keep legs at slightly elevated position when lying down
home remedies for swollen feet during

CALL THE DOC!!!


  • Vaginal bleeding – sign of miscarriage or low placental position
  • Abdominal pain – regular, painful uterine contractions, sign of preterm labor
  • Severe headache or limbs swelling – to rule out any increase in B.P
reasons to call doctor during pregnancy

The Third Trimester

Trimester Three and the count down starts

Weeks 29-34

Lanugo starts to disappear and the skin becomes pinkish. The baby appears rounder. His/Her movements are more varied and may alternate between a state of rest and active moving

Weeks 35-40

By now, the baby has fully formed and the head is more proportionate to the size of his/her body. The lanugo would have completely disappeared and the baby’s skin is now smooth

As the due date approaches, the baby’s head will begin to descend into your pelvis – a phenomenon known as “engagement”. The baby’s weight continues to increase such that he/she usually weighs more than 2.8 KG at the time of delivery

pregnancy pictures of third trimester of pregnancy
Common Symptoms

Frequent Urination

Cause

Pressure of growing belly initially and then later the baby’s head pressing on bladder along with water retention, may lead to frequent urination

Tips

  • Should not be associated with burning sensation or blood in urine
frequent urination during pregnancy

Piles

Cause

Hormonal changes and increasing abdominal pressure can lead to lumps at the anus

Tips

  • Avoid constipation
  • Avoid sitting or standing for long periods
  • Hot or cold compresses may provide relief

Heartburn / Reflux

Cause

Gradually enlarging uterus pushes on stomach and causes acidic contents to flow back into food pipe

Tips

  • Eat small, frequent meals
  • Do not lie down immediately after meals
  • Drink a glass of cold milk to ease the heartburn
  • Propped up position when sleeping
acid reflux pregnancy


Vaginal Discharge

Cause

  • Increased blood flow to vaginal area can cause clear, milky or odorless discharge, should not be associated with itching
  • Practice good perineal hygiene

Varicose Veins

Cause

Extra weight of baby putting pressure on veins causes bluish, enlarged veins on back of calves, legs or thighs

What to pack to the Hospital

If organization is your style, be sure to pack your bag early by the 36th week or so as to not get flustered about it towards the end. Some may prefer to pack two bags, one for the labour room and one to use after the delivery during the hospital stay

how to prepare bag for the delivery

For the Labour Room

  • Comfortable night gown which you would not mind getting stains on
  • Soft flannel cloths to wipe your face
  • Lip balm as the lips tend to get dry and cracked
  • Pair of thick socks to keep warm
  • Hot water bottle to relieve back aches or pain in the legs
  • Moisturising lotion to use for massage
  • Favorite pillow or comfort blanket (if you have one)
  • Dry snacks like biscuits, crackers and drinks to consume when you don't feel like eating anything heavy
  • And last but not the least, a camera to take your baby's first picture!
birthing room equipment

For the Baby

  • Easy to wear newborn clothes (ones with ties over each shoulder are easiest)
  • Washable baby diapers (choose slightly thicker ones which will absorb the wetness)
  • New born disposable diapers (can be used all the time or in the nights at least)
  • Flannel soft cloths to wipe the baby's mouth
  • Soft flannel baby blankets to wrap the baby securely
  • Wet wipes
  • Baby toiletries (baby bath lotion, body lotion, powder with box and puff, diaper rash cream)
  • Rubber sheets or Quick dry sheets which are softer (keep 3 or more because they may need to be changed frequently)

newborn baby things images

Labour & Delivery

First Stage

  • When the cervix or mouth of uterus opens up to 10 CM
  • Latent Phase – when the cervix dilates to about 3 CM – can last for many hours especially in the primis
  • Active Phase – contractions more strong & regular, after 3 CM dilatation
Second Stage

  • After full dilatation, when contractions are more intense and you are encouraged to bear down or ‘push’
  • The contractions help to push the baby through the birth canal and the vagina. The doctor performs an episiotomy if necessary and delivers the baby
Third Stage

  • Stage after birth of the baby to delivery of the placenta

pictures of labor in pregnancy

Postnatal Period

  • Well, the event you were anticipating for ten long months is over and your baby is finally in your arms, it is time for celebration
  • But also keep in mind that the real work does not end but rather Starts With Delivery
  • The newborn period is a stressful time in anyone’s life, with the lack of sleep and adapting to your baby’s routines
  • Take it a day at a time and most importantly catch up on sleep when the baby is sleeping (day or night)
  • Remember that babies do not behave like the cute ones shown in commercials and that it will take a few weeks for you and the little one to establish some sort of routine
  • Moisturising lotion to use for massage
  • Your body will not spring back to normalcy immediately and will take about 6 weeks for all the aches & pains to slowly disappear
  • Eat sensibly as you did in pregnancy and remember that you do not have to eat for two to get enough milk
  • Not everyone has inborn maternal instincts and talents but you will definitely learn on the job, so RELAX and enjoy your little one

postnatal care photo

Breast Feeding


  • Have no doubt, BREAST MILK IS THE BEST MILK for your baby
  • Breastfeeding is initiated almost immediately in most cases, except in few situations when the doctor advices you on when to start
  • The first secretion or COLOSTRUM which comes in the first two days is watery but energy rich and helps in building the baby’s immunity for later life
  • Good latch on – the areola (dark skin around nipple) should be drawn into the baby’s mouth rather than only the nipple going in. This is essential to avoid sore cracked nipples and many common feeding problems
  • Exclusive breast feeding (no water / gripe water or formula feeds) is best for the baby and all that he/she requires in the initial six months
  • Supply and demand may take a few days to weeks to get established, so be patient
  • Though it feels like it, you WILL NOT spend your whole life breastfeeding and as soon as a pattern gets established, there is nothing easier than it (no need for bottles / brushes / sterilizers)
  • Remember to drink plenty of fluids during lactation. Drinking ONLY milk is not necessary as there is no direct connection
  • MAIN CAUSE FOR good milk secretion is the baby sucking at the breast and no amount of garlic or fish will increase the supply like making the baby suck regularly
  • Adopt a comfortable posture which will avoid back or neck strain. See below for different holds and respective images

breastfeeding photos




breastfeeding baby pictures
cradle hold breastfeeding

Cradle hold
cross hold breastfeeding

Cross cradle hold

football hold position

Football hold

Breastfeeding at work

There is no need to stop breastfeeding just because you are returning to work. With a bit of planning, your baby can still be fully breastfed and receive the best nourishment. Here are some tips to help you juggle with resuming to breastfeed:

  • Two weeks before your maternity leave ends, start expressing and storing your milk
  • Feed your baby just before you go to work, and as soon as you return home
  • While you are at work, express and store the breast milk in the fridge (usually at lunch break and just before leaving)

If you have problems with lactation or are worried, speak to your doctor, lactation consultants or even mothers who have balanced breastfeeding and work

Expressing breast milk

You can express your breast milk manually by using your hands or with a manual or electrical breast pump

How to express breast milk with a breast pump?

  • Wash hands thoroughly before expressing milk
  • Ensure all the equipments are clean and sterilised
  • Use your pump correctly, starting with low pressure and switching between breasts after 5-10 minutes of expressing milk
  • Express your breast milk every three hours and store the breast milk in the refrigerator or freezer
breast images with milk
manual breast pump

Thawing process

  • Thaw frozen milk in the refrigerator or in a cup of warm water
  • Use the milk immediately or within one hour
  • Avoid boiling or heating breast milk in a microwave
thawing milk

Storage of the expressed milk

Place of Storage Recommended Storage Duration
Expressed milk at room temperature of 250C 4 hours
Expressed milk in a cooler with ice pack at 150C 24 hours
Breast milk freshly expressed and stored in the fridge at 40C 48 hours
Frozen milk in 2-door fridge stored at -50C to -150C 3 - 6 hours
Frozen milk in deep freezer at -200C 6 - 12 months
Thawed breast milk stored in the fridge at 40C 24 hours

CALL THE DOC!!!

Labor Pains

Regular, painful uterine contractions starting in the lower back and spreading to abdomen and back of legs. Not relieved by rest, will increase in intensity as well as frequency

Vaginal Bleeding

Mild bloody discharge or ‘show’ – could be due to dislodgement of mucus plug from the mouth of the uterus and can herald onset of labor

Reduced Fetal Movements

Though intensity of rolling movements may reduce as baby grows, frequency should be maintained

Leaking of Water

Sudden gush or continuous slow trickle of clear fluid may denote rupture of your bag of membranes

reasons to call doctor during pregnancy

Nutrition

Well now that you are pregnant, you will be likely to get a lot of advice (wanted and unwanted) from all quarters as to what you should eat or not eat, do or do not etc. Some of the advice may be helpful definitely but what we should keep in mind is that each pregnancy is unique and what works for one person may not necessarily work for another.

nutritious food during pregnancy

Facts:

Additional calories required in the first trimester are minimal if you are a healthy person and even in the second and third trimesters a woman requires only about 300 calories additionally per day (over the 1800 to 2200 cal requirement for non pregnant women). SO…DO NOT EAT FOR TWO.

The extra calories needed in the first trimester will be provided by a glass of milk!!! So do not think that being pregnant gives you license to indulge in whatever you want as you will have to struggle postpartum to lose all the unwanted weight.

Your caloric needs may differ according to your pre-pregnancy weight and health.

Quality rather than Quantity:

Eating better is not equivalent to eating more. Making the 300 extra calories count and contribute is what is important as they can come from two doughnuts or an egg and cheese sandwich for example.

Limit intake of junk food, frozen dinners or takeaways as they will provide only empty calories which will make you pile on weight rather than helping the baby grow.

Eating Healthy:

It is important to include a variety of foods from the three major food groups, namely:


  • Carbohydrates: 4 to 6 servings needed - Whole grains are best. Brown bread, rice, pasta, cereals, muffins etc.
  • Proteins: 2 to 4 servings needed - Cooked meat, fish or poultry, eggs, beans, tofu, soya milk, pulses, sundal etc.
  • Fats: 2 to 3 servings - Unsaturated fats are best. 1 tsp vegetable oil, 1 tsp mayonnaise, 6 almonds, 20 cashews etc.

what to eat during pregnancy

In addition we should also include,

  • High calcium foods: 2 to 4 servings required. Low fat alternatives are best. 250 ml milk or yoghurt, paneer, hard cheeses, soya milk, ice-cream etc
  • Fruits and vegetables: 5 or more servings daily. Fresh produce is best. Salads, fresh fruits, dry fruits or juices without sugar.

Diet in Pregnancy

Nutrient Table
Nutrient What it does Food Sources
Folate Helps prevent neural tube defects (malformations of the brain and spinal card) in fetuses and anemia in pregnant women Dark green leafy vegetables, citrus fruits and juices lentils, fortified foods
Iron Aids in the formation of red blood cells and prevention of anemia in pregnant mothers Red Meat, chicken, eggs, fortified cereals, green leafy vegetables, legumes, nuts and dates
Vitamin C Enhances iron absorption Citrus fruits and vegetables
Calcium For building baby's strong bones and teeth Dairy foods such as milk, yoghurt, cheese, leafy green vegetables such as broccoli, kale, spinach, nuts & tofu (calcium-fortified)
DHA (Docosahexaenoic acid) One of the omega-3 fatty acids that is important for brain and eye development Fish, plant sources including a wide variety of seeds and nuts such as flaxseeds and walnuts
Vitamin A For normal growth and vision Eggs, milk, red and yellow fruit, red and green vegetables

Food Groups

Food Groups Recommended Numbers of Servings Per Day
Rice and Alternatives (Do include the recommended whole-grain serving as part of the Rice and Alternatives serving needs) 6-7
Whole-grains 3
Fruits 2
Vegetables 3
DHA Meat and Alternatives 2 1/2
Milk (Do include the recommended milk serving in addition to the Meat and Alternatives serving needs) 500 ML

Serving Sizes

Rice and Alternatives Vegetables

  • 2 slices bread (60 G)
  • 1/2 bowl* rice (100 G)
  • 1/2 bowl noodles, spaghetti or 3 beehoon (100 G)
  • 4 plain biscuits
  • 1 dosa (60 G)
  • 2 small chapatis (60 G)
  • 1 large potato (180 G)
  • 1 1/2 cups plain cornflakes(40 G)

  • 3/4 mug** cooked leafy vegetables (100 G)
  • 3/4 mug cooked non-leafy vegetables 100 G)
  • 150 G raw leafy vegetables
  • 100 G raw non-leafy vegetables
Fruits Meat and Alternatives

  • 1 small apple, orange, pear or mango (130 G)
  • 1 wedge pineapple, papaya or watermelon (130 G)
  • 10 grapes (50 G)
  • 1 medium banana
  • 1/4 cup*** dried fruit (40 G)
  • 1 glass pure fruit juice (250 ML)

  • 1 palm-sized piece fish, lean, meat or skinless poultry (90 G)
  • 2 small blocks soft tofu (170 G)
  • 3/4 cup cooked pulses (e.g., lentils, peas, beans) (120 G)

* Rice bowl       ** 250 ML mug      *** 250 ML cup      ^ 10-inch plate

Healthy Snacks

Some pregnant women take smaller but more frequent meals. If you need a small snacks in between main meals, here are some ideas:

Cereal 'n' milk

Have whole-grain cereal or oats with low-fat milk. Top with some sliced fruit

Handful of Nuts

Have a handful of mixed nuts for a quicksnack or mix some ready-to-eat cereal, dried fruit and nuts in a sandwich bag for a snack on-the-go!

Sandwiches

Toast wholemeal bread and include different fillings (e.g., baked beans, low-fat cheese, an omelette)

Fruit Kebabs

Thread some cubes of different fruit to sticks and serve with a small tub of low-fat yoghurt

Corn-on-the-Cob

Brush olive oil over steamed corn

Homemade Milkshake

Blend the fruit of your choice with low fat milk for a delicious smoothie

Sundal

fruits for pregnant ladies


Debunking Common Food Myths

  • You do not need to eat for two
  • Quality is anyday more important than quantity
  • Eating papaya, pineapple or'heat generating' foods will not lead to miscarriages
  • Full cream milk is not more nutritious than low fat or skimmed milk products
  • Eating dark colored foods or taking iron supplements will not lead to dark skinned babies
  • Taking saffron in milk will not lead to fair skinned babies
  • Drinking too much or too little of water has nothing to do with the amniotic fluid level surrounding the baby - recommended to drink 8-10 glasses of water a day at least
  • Taking lots of ghee will not failitate an easier vaginal delivery
diet for pregnant women


Guidelines For Pregnancy Weight Gain

BMI (Pre-Pregnancy) Recommended Weight Gain (During Pregnancy) Recommended Weight Gain for Twin/Multiple Births
less than 18.5 12.7 – 18.1 KG Discuss with your obstetrician and/or dietician
18.5 – 24.9 11.3 – 15.9 KG 16.8 – 24.5 KG
25.0 – 29.9 6.8 – 11.3 KG 14.1 – 22.7 KG
>= 30 5.0 – 9.1 KG 11.3 – 19.1 KG

Being Fit

  • Getting pregnant does not mean cessation of all physical activities, unless you have any medical problems or a high risk pregnancy
  • Do not start any new exercise routines in pregnancy
  • Normally, brisk walking, swimming or stationary cycling are suitable throughout pregnancy
  • Do not over exert yourself – you should be able to carry on a conversation while exercising
  • Stay hydrated
  • Stop if you feel any abdominal pain / bleeding in vagina / chest pains / dizziness
pregnancy workouts

Big No's

things to avoid during pregnancy

Smoking: Not only active smoking, but even passive smoking is to be avoided in pregnancy. Nicotine crosses the placenta, constricting the baby's blood vessels and depriving the baby of oxygen and nourishment. Smoking also increases problems during pregnancy such as miscarriages or premature labor.



do and don ts in pregnancy


Alcohol: Pregnancy is a time when it is better to give up alcohol totally. Drinking excessive amounts of alcohol during pregnancy is known to cause learning disabilities, physical defects, and emotional problems in children. The implications of drinking even the smallest quantities of alcohol are not known. So, our best bet is to be wise and refrain.


avoid things during pregnancy

Caffeine: There are some studies that suggest that drinking more than four cups of coffee a day may increase the chances of miscarriage. The stimulant caffeine which is found in coffee, tea, soft drinks, and chocolate may interfere with iron utilization. Decaffeinated coffee, herbal tea or fruit juices may be substituted. Drugs and


causes of self medication in pregnancy
Self Medication

Do not expose yourself to any medications without consulting with your doctor beforehand. This is because both prescription and over the counter drugs are potentially harmful to the baby in pregnancy.




Staying in Shape

If you are physically fit and were following a regular exercise routine prior to pregnancy, it should generally be possible to continue with it along with a few modifications throughout the nine months.

yoga in pregnancy

Do not try to exceed pre pregnancy levels.

After the first trimester try and avoid exercises that require you to lie flat on your back or stand in one place for long periods of time.

When you exercise remember to drink plenty of fluids to stay hydrated.

Do not over exert yourself and listen to your body if it signals that it is fatigued.

Always perform a few gentle stretches before starting to exercise as this will prevent your muscles from over stretching.

If you are feeling too warm or hot, decrease the intensity of exercise as the baby can suffer developmental harm if the core temperature increases above 100 degrees Fahrenheit.

When doing floor exercises, rise gradually to avoid a sudden, rapid decrease in blood pressure, which may result in a momentary black out.

STOP exercising if you experience dizziness, shortness of breath, vaginal bleeding or abdominal cramps.

The most comfortable exercises for pregnancy are walking, yoga, pilates, swimming, low impact exercises, stationary cycling, tennis or golf. Swimming is one of the best forms of exercise in pregnancy as our weight is supported by the water and it is difficult to strain muscles and joints. Be sure to include exercises for the muscles of the pelvic floor in your daily routine.


pelvic tilt exercise pregnancy



Contact Us

K.M SPECIALITY HOSPITAL &
Bloom – Centre for Woman & Child Wellness

No. 453/454, R.K. Shanmugam Salai, K.K. Nagar,
Chennai - 600 078