A day at the ante-natal clinic

The phenomenon of pregnancy, even though has been and is still being extensively researched, remains one of the most complex biological processes in existence. The changes it brings about in women is nothing short of a miracle, only that miracles are not recognized in science. We all know someone that knows someone whose body has been transformed just by being pregnant and giving birth. Women have moved from being petite to being obese, and vice versa, just within the 9-month gestation period and giving birth. Personally, I have seen someone becoming mentally unstable after going through the process of pregnancy and giving birth.

Scientists have tried and are still trying as much as possible to research the complex process in order to better understand the body of a woman and the associated changes. But each time they make a breakthrough in one aspect, a new case usually comes up. The thought of all these was what was going through my mind a few days ago when I decided to accompany a pregnant friend to her ante-natal schedule. I will call this friend 'ABC'.

^{By Rudy and Peter Skitterians on pixabay}

The Mother's Vitals

On getting to the clinic, the first thing the nurses did was to check the vitals of ABC. The components of the vitals checked include temperature, weight, and blood pressure.

While the body temperature of pregnant women is not expected to vary significantly from the normal temperature, the weight has been researched to vary to the point of being dramatic in some women. Pregnant women gain or lose weight due to a change in eating habits/hormones and a host of environmental factors during the gestation period. The variation in the amount of weight gain or loss can be as high as more than 30kg or 66 lb. The bulk of the weight gained during the 9-month period usually occurs at the last trimester period.

The physiologic processes associated with pregnancy also make the blood pressure of many pregnant women vary during the course of pregnancy. Many other factors also correlate with the blood pressure including the diet of a woman during the gestation period, the stress level, as well as genetic factors. Generally, people with histories of high blood pressure in the family are more likely to develop high blood pressure at some points in their lives, other factors being held constant. More specifically, it is not unusual for the blood pressure of a pregnant woman to drop a bit between the 5th week and second trimester of a pregnancy before returning to normal thereafter.

ABC's vitals seemed to be fine when compared to the baseline values (the vitals before she got pregnant) except for the blood pressure that was found to be particularly high. It is not unusual for pregnant women to experience elevated blood pressure levels compared to when they are not pregnant due to some biological factors, but pregnancy-related high blood pressures have been found to sometimes be an indication of a much complex abnormality, especially if it is associated with the presence of excessive protein in the urine (proteinuria). The abnormality is known as pre-eclampsia.

After the discovery, ABC was recommended to quickly run a proteinuria test. Luckily for her, the test came out negative, leaving a little cause for concern. Whatever the reason for the high blood pressure, drugs will take care of it. Hence, ABC was prescribed 20 mg Nifedipine and methyldopa be simultaneously taken to tackle the high blood pressure.

^{By fernando zhiminaicela on pixabay}

Fetal Heart Rate

Thereafter, the attention shifted to the baby in the womb. The doctor felt the heartbeat of the baby using a Doppler fetal monitor and made a comment that the heartbeat of the baby was unusually high. According to research, the normal heartbeat of a growing fetus is supposed to vary between 110 to 160 beats per minute, although some reported outliers of 5 to 25 beats per minute. Some quarters also reported a correlation between heartbeat rate and the sex of fetuses.

The fetal heart rate of ABC's baby was found to be about 170 beats per minute and the doctor said this might be due to inadequate oxygen for the baby. He quickly recommended an ultrasound test and one of the fallouts from the test was that the amniotic fluid has reduced a bit. At the end of the session, it was recommended that ABC gets admitted for, at least, 24 hours for comprehensive monitoring of the baby. During this period, ABC would be put on intravenous lactate drips to bring the amniotic fluid back to normal. The hypothesis was that the reduction in the amniotic fluid could be responsible for the elevated heart rate of the fetus and once the normal fluid is restored, the heart rate should also return to normal.

The doctor, however, opined that if the heart rate of the fetus does not return back to normal after the intravenous lactate regime, ABC might be required to be put on oxygen in order to supplement the oxygen available for the fetus.

The admission

ABC was admitted immediately and was placed on the lactate drip as recommended by the doctor. The fetal heart rate was monitored at regular intervals and was found to be back to normal in some cases and elevated in a few. At the end of the admission period (24 hours), the doctor recommended that AC be discharged without a need to be placed on oxygen. However, the doctor advised ABC to observe a lot of rest as she would soon be due and also gave her a card to be ticked each time the baby moves in order to monitor the level of activeness of the baby. The next ante-natal was scheduled for less than a week.

It was really an interesting and educative episode for me.

Thank you all for reading.

Summary

I accompanied a pregnant friend to one of her ante-natal schedules where she was discovered to have high blood pressure along with an abnormally high heart rate of her baby. The doctor thought the high blood pressure could be an indication of preeclampsia and recommended a confirmatory test of proteinuria. The confirmatory test was negative and my friend was just prescribed anti-high blood pressure drugs in the form of Nifedipine and Methyldopa. The abnormally high fetal heart rate was linked to a reduction in the amniotic fluid as indicated by an ultrasound result. She was placed under observation for 24 hours with lactate drips (to raise the amniotic fluid back to normal) and continuous monitoring of the fetal heart rate. She was later discharged but told to keep a close watch on the baby's movement against the next ante-natal schedule which is less than a week.

Resources

• Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Pregnancy: Part I Weight Gain: Part II Nutrient Supplements. Washington (DC): National Academies Press (US); 1990. 5, Total Amount and Pattern of Weight Gain: Physiologic and Maternal Determinants.
• https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745
• https://www.medicalnewstoday.com/articles/322914