Balanced Diet – In Pregnancy

A Balanced Diet is a Must! – In Pregnancy.

We are what we eat, and diet based on fresh, light, nutritional foods, such as fruit, vegetables and grains keeps the body lean, agile and the mind clear and sharp. For you, as a pregnant mother, this is even more vital as your health and vitality will determine the health and vitality of your unborn child. Your diet should contain adequate quantities of proteins, minerals and vitamins for both a healthy you and your baby.

                Protein is required during pregnancy to support the growing foetus and the placenta. It can be obtained in generous amounts from lentils, peas, beans, nuts and soya products. These can be taken in combination with whole grains such as wheat, oats, corn, barley, etc. It is better to avoid red meat as it could lead to constipation. Besides, meat only adds toxins to the body.
                Calcium is required at every stage of pregnancy as it helps in the development of your baby’s bones and teeth. Women should increase the intake of calcium during pregnancy in order to meet the foetus needs without compromising their own bone density. Deficiency of calcium can lead to weakness and acute pain in the bones and joints of the expectant mother, making it difficult to carry on with the pregnancy.  Deficiency of calcium can ultimately lead to development of rickets in your growing child. Good sources of calcium are soya, nuts and dairy products like milk, curd, cottage cheese, soya and nuts.

Iron and Folic Acid
Iron is necessary for the development of haemoglobin- the carrier of oxygen in the blood. Haemoglobin is attached to red blood cells and it is because of this component that oxygen is able to move from the lungs to different parts of the body. Deficiency of haemoglobin results in anemia, which subsequently leads to weakness, breathlessness and fatigue. Dietary sources of iron are green leafy vegetables, egg yolk, raisins, apricots, cereals, whole grin, bread and liver. Folic acid is easily available in jiggery, pulses and dairy products.
Vitamins
Vitamins promote good eyesight, healthy teeth, clear skin, and general growth and vitality. They build resistance to infection and are very necessary during pregnancy and lactation. Natural sources of vitamins are fruits, milk and milk products and vegetables. Vitamins C and D increase resistance to infection and hold the body cells together. Vitamin C is available in citrus fruits, papaya mango, tomato, potato as also in minor amounts in other fruits and vegetables. Vitamin D is available from sunlight and natural fruits and vegetables that are full of this prana.
Fibre
A very important component in diet during this period, as pregnant women normally tends to suffer from constipation due to the extra intake of iron. Try and eat lots of fruits and vegetables, whole grains and cereals to add fibre to the diet. Fibre is rich in polyunsaturated fats that help control blood cholesterol.
Liquids
Equally important is intake of plenty of fluids. Drink lots of water and fresh juices, but limit your consumption of tea, coffee and aerated drinks. Drinking fruit juice or herbal tea is definitely preferable to drinking plain tea. We do not recommend alcohol to pregnant mothers. Not only does it get absorbed into your bloodstream, and that of your baby, you also run the risk of suffering from slower reflexes and loss of muscle coordination, thus placing both yourself and your baby at risk.

Mountain Pose or Parvatasana

Mountain Pose or Parvatasana

This asana makes the entire body strong. The abdominal muscles are drawn toward the spine when breathing deep. It strengthens the internal organs and has a profound effect on the reproductive organs.

·         Lie down on the floor on your stomach, i.e. with your face downwards. Keep your feet about 2.5 cm apart.

·         Rest your palms by the side of your chest, with fingers straight out, pointing towards your head.

·         Exhale. Raise your hips, lowering your head between your arms. You will be forming a triangle with your back and legs.

·         Try to keep your legs stiff. Do not bend your knees but try to press your heels and the soles of your feet on the floor. Also try to bring your head towards your knees.

·         Stay in this position for thirty to forty seconds while breathing deeply.

·         Release the posture by lifting your head forward, stretching your torso forward and lowering your body gently down to the floor.  

Shoulder Stand Pose or Sarvang Asana

Shoulder Stand Pose or Sarvang Asana

This asana balances your endocrine glands to your hormonal levels. It regulates menstrual activity and also is very beneficial for women suffering from a displaced uterus.

·         Lie on your back and flex your toes inward. Place your palms facing down, close to your hips. Inhale; push down on your hands and raise your legs straight up and above you.

·         Left your hips off the floor and bring your legs up, over and beyond your head at an angle of about 45⁰.

·         Exhale, bend your arms and support your body, holding as near the shoulders as possible, thumbs around the front of the body, fingers around the back. Push your back up and lift your legs.

·         Straighten your spine and bring the legs up to a vertical position. Press your chin firmly into the base of your throat. Gradually try to get your elbows closer together and your hands further down your back, towards the shoulders, so as to straighten your back.

·         Breathe normally while doing this posture and while holding it. Stay in this position 20 to 30 seconds.

·         Bend your knees and pull them to your forehead or chest; then gently lower your body, releasing the position.

Take care not to jerk into the posture instead gently keep pulling your body up into the final position.

Yoga for Conception

Yoga for Conception

So you are planning to start a family. Then you must know that the implications of bringing a child into this world are enormous- not only on you as a mother-to-be, but on your partner and on your lifestyle as well. But if the timing is right, and you are mentally prepared, then you should start preparing your body for pregnancy at least a year in advance.

                Time and again it has been proven that stress is one of the biggest blocks to getting pregnant. In this busy world it becomes harder to find the inner peace that our body and mind craves for. Yoga is a mind and body exercise that enables you to recharge at all levels and allows your body and mind to work with its innate magic.

                Start on a protein diet and increase your intake of green vegetables and fruits, reducing fried and junk food, thus cleaning your body of toxins. Those of you, who have been on a contraceptive pill, give yourselves three months without it to let your body get used to the new situation. Visit a gynecologist and make yourself familiar with what is going to happen. It is important that you get yourself checked for Rubella virus. Take special care of yourself so as to make your body’s stay comfortable.

                The way to approach your conception is to create the correct environment for becoming pregnant, which means that as a prospective parent, your body must be in optimum health and in fit condition to facilitate conception. In addition, your mind must be calm and positive. Time and again it has been proven that stress is one of the biggest blocks to getting pregnant.

                The result of a balanced yoga session will give you tranquility o mind and the body will feel rested and energized. Your internal organs will feel recharged and this will allow them to function more effectively. Therefore if you are having trouble conceiving you should give yoga a try. By starting early, you will develop all the good habits that are essential to carry, protect and nourish your unborn child when the time comes.

                The regular practice of hatha yoga will help achieve hormonal balance, regulate irregular menstrual cycles and tone all the reproductive organs. Yoga postures foster awareness of feelings, both physical and emotional. They build strength and flexibility and also help in lubricating the joints and in releasing the toxins that build up in the body. The various postures also tone the muscles of the spine and strengthen the entire physical body-internally as well as externally, making it fit to carry a new life inside it for nine months.

                The asanas describes in this section should be done before one decides to conceive. Once you become pregnant, you can make changes and add new asanas that will help and support you through your pregnancy.

Remember to Pregnancy

For Pregnancy

Throughout your pregnancy baby is dependent on you for all its dietary need. This means that you should pay special attention to what you eat. A poor diet during pregnancy will not only take its toll on your own health, but can also have life-long repercussions on the physical and mental well-being of your child. A pregnant woman should eat a well-balanced diet, but at the same time keep track of her weight gain. Women who experience morning sickness or nausea in the first trimester are sometimes unable to eat properly. In fact, many mothers-to-be tend to lose weight during this period. However, this should not worry the expectant mother, unless it continues even after the third month; then it becomes advisable to seek the doctor’s help. Food aversions are extremely common in pregnancy and are believed to be due to the hormonal changes taking place in the body.

                From the third month on wards, when your baby starts to develop and grow, you will find a change in your appetite. Your hunger will return! This is the time to nourish you with a well-balanced and nutritious diet. It is important that women should gain weight during pregnancy. Not gaining enough weight makes for a low-weight baby who might face health problems; on the other hand, too much weight may make the delivery a bit too difficult. The ideal weight gain during your pregnancy is between 9 to 13 Kg. Any weight gain beyond this will stay with your after your delivery. Make sure not to restrict your diet during pregnancy because otherwise your diet may lack the right amount of nutrients required for the growth of the baby.

Remember to

a.       Eat small portions of food at regular intervals. Avoid consuming large quantities of food at meal times.
b.      Keep fruits, nuts and biscuits handy for those intermediate hunger pages.
c.       Avoid smoking and alcohol.
d.      Reduce your intake of tea and coffee.
e.      Avoid heavy and spicy foods as these may cause flatulence. Keep your salt intake low.
f.        Eat at least two portions of fruits and vegetables. Avoid aerated drinks as this will lead to unwanted calories. Instead, substitute with fresh fruit and vegetable juice.
g.       Add honey instead of refined sugar to your milk. And in general, limit all kinds of sugar.
h.      Eat only when you are genuinely hungry.
i.         Eat slowly and chew your food well.
j.        Avoid tranquillizers and drugs in general, unless you are prescribed one by your doctor/gynecologist. If you have an over powering need to take a drug, then consult your doctor. Just remember that drugs have serious effects on the unborn fetus.

Relaxation or Yoga Nidra

Relaxation or yoga Nidra

The state of our minds and the state of our bodies are intimately linked. If our muscles are relaxed, then our mind too is relaxed. In today’s world, we are bombarded with stimuli that leave our bodies in physical and mental tension. Such undue tension drains us of our energy and becomes the major cause of our tiredness and ill health.

                Relaxation releases the muscular tension, infusing the body with serenity. To relax is to rejuvenate. To rejuvenate is the key to good health, vitality and peace of mind. Yoga nidra is a gentle relaxation technique that requires a few minutes and is very effective in our day-to-day lives.

a.       Lie down in balasana and make yourself comfortable. Relax your body and focus on your breathing.

b.      Relax your body physically by mentally starting from the toes and moving upwards slowly, till your entire body is relaxed.

c.       Your mind can be relaxed by focusing on your rhythmic breathing and letting no other thought to creep in.

d.      Stay in this position for as long as you want.

Mantra Meditation or Japa Meditation

Mantra Meditation or Japa Meditation

Sound is a form of energy that is made up of vibrations and wavelengths. Mantras are Sanskrit syllables, when chanted, will take you to a higher stage of consciousness. Sincere practice and repetition of a mantra lead to birth of pure thought. Mantra meditation calms the body and mind. It induces a state of silence and stillness. The vibration of the chant has a very soothing and positive effect on you and your baby.

a.       Sit in a comfortable cross-legged position with the spine held erect, or preferable still, sit against a wall, as you will be more comfortable and less distracted. Cushions and bolsters may also be used as per your needs.

b.      Place your hands on your knees with palms upward and the fingers in the chin mudra, i.e. your thumb pressing the tip of your index finger. Relax your body and calm your breathing.

c.       Gently focus your eyes on the point between your eye-brows –the ajna charka.

d.      Feel your breath moving in and out of your body. Visualize that from this point you are sending all your energy to your baby.

e.      Now chant a mantra or the cosmic sound, OM. First chant loudly for a few seconds, and then slow it down to a whisper that you only can hear. Then chant it mentally 108 times. ( You could also use a Japa mala to keep a track of the cunts)

f.        Continue till you are comfortable and then lie down in balasana.

One can also use a japa meditation to keep the mind from distraction. Listening to mantra or spiritual music can be another option.

Drug Induced Acute Renal Failure in Pregnancy –Management.

Drug Induced Acute Renal Failure in Pregnancy –Management.

The goal of treatment is to identify the drug which may cause acute renal failure and treat any reversible causes of the kidney failure such as use of kidney-toxic medications.

                Treatment also focuses on preventing excess accumulation of fluids and wastes, while allowing the kidneys to heal and gradually resume their normal function. Hospitalization is required for treatment and monitoring.

It is dividing into

A.      Medical Management

B.      Obstetrical Management

Medical Management

Reversible Prerenal acute Renal Failure

a.       Establish and correct the underlying cause of ARF

b.      Hypovolemia if present restore blood volume as rapidly as possible depending on what is lost

c.       Optimize systemic hemodynamic. Measurement of central venous pressure or pulmonary wedge pressure as adjunct to clinical examination may aid in determining the rate of administration of fluid.

d.      Correct metabolic acidosis- restoration of blood volume will correct acidosis by restoring kidney function, isotonic sodium bicarbonate may be used

e.      Recent trials do not support use of low dose dopamine in severely ill patients at risk of ARF.

Re-established Acute Renal Failure

Emergency Resuscitation

a.       Hyperkalemia should be corrected immediately

b.      Circulating blood volume should be optimized to ensure adequate renal perfusion

c.       Severe acidosis can be ameliorated with isotonic sodium bicarbonate.

Fluid and Electrolyte Balance

a.       Daily fluid intake should be equal to urine output, plus additional 500 ml to cover insensible losses

b.      Measurement of fluid intake and output should be weighed daily

c.       Since sodium, potassium are retained hence intake of these substances should be restricted.

Protein and Energy intake

It’s important to give energy and nitrogen to hyper catabolic patients in adequate.

Infection Control

Regular clinical examination and microbiological investigation should be done to reduce any complication.

Drugs

NSAID and ACE inhibitors may prolong ARF hence temporary withdrawal should be considered.

Hemodialysis

Dialysis may be used to remove excess waste and fluids. This often makes the person feel better and may make the kidney failure easier to control. Dialysis may not be necessary for all people, but is frequently lifesaving, particularly if serum potassium is dangerously high.

Hemofiltration

Used to remove excess of body water along with electrolytes across high flux semi permeable membrane.

Peritoneal Dialysis

This can correct electrolyte imbalance and equally effective as hemodialysis.

Supportive Therapy

a.       To control infection if indicated

b.      Vitamins

c.       Blood transfusion

d.      Control of hyperphoshatemia

Phase of Diuresis

a.       Intake and output chart should be maintained and serum electrolytes are monitored

b.      To control fluid balance

c.       To control electrolyte balance

d.      Supplementation of salt-5 gm sodium chloride for each liter of urine passed.

Phase of Recovery

Clinical improvement along with increased amount of urine with more and more concentrating power is evidenced with diurnal variation of specific gravity between 1002-1020 were observed. Diet and food as per patient’s desire.

Obstetrical Management

Prerenal-any condition leads to hypovolemis, hypotension, volume contraction and low cardiac output.

Early Pregnancy

a.       Severe dehydration due to Hyperamesis gravidarum and acute pyelonephritis = replacement of fluid along with electrolye, and monitoring of kidney function

b.      Severe infection due to septic abortion = antibiotic metrogyl, laparotomy if indicated

c.       Acute and massive blood loss due to abortion, ectopic pregnancy and hydatidiform mole = surgical management

Mid Pregnancy

a.       APH-abruptio placenta, placenta previa = immediate surgical intervention

b.      Pre-eclampsia and eclampsia and HELLP syndrome =antihypertensive, anticonvulsion along with other medical management.

Late pregnancy and labor

a.       Severe uterine infection due to intrauterine death of fetus, or chorioamnonities = antibiotic

b.      PPH = medical and surgical management

c.       Traumatic delivery- surgical management.

Immediate postpartum

a.       Puerperal sepsis due to chorioamnonitis- treated by antibiotics

b.      Drug sensitivity due to ergot treatment of hypersensitivity

c.       Consumptive coagulopathy- by fresh blood transfusion, plasma or platelet transfusion heparin, etc.

Prognosis

Although acute renal failure is potentially life-threatening and may require intensive treatment, it usually reverses within several weeks to a few months after the underlying cause been treated.

                Conservative management when failed, may progress to chronic renal failure and/or end-stage renal disease. Death is most common when the cause of kidney failure is related to surgery or trauma or when it occurs in people with coexisting heart disease, lung disease or recent stroke. Old age, infection, loss of blood from the GI tract, and progression of the kidney failure also increase the risk of death.

Used During Labor –Effects on the Baby

Systemic Analgesics Drugs Used During Labor –Effects on the Baby

There is no single ideal analgesic agent for use in labor. All analgesic drugs cross the placenta and depress the fetus. The degree of depression will depend on the dose of the drug the length of time of exposure and the maturity and well- being of the fetus.

                Although the opiates are the most effective analgesic drugs available, their use in obstetrics is losing favor because of the depressant effect on the neonate, the effect of the mother’s psyche, making her less aware of her experience of childbirth, and because in doses that minimize side effects the pain relief is poor.            

                The most commonly used opiate in labor is pethidine, although diamorphine and fetanyl are also used. The maternal side effects of narcotics are dose related and include hypoventilation, postural hypotension, postural pypotension and loss of consciousness. Emetic effects of all opiates are also dose-related but this varies in individual paticents. Grastric motility is decrease by narcotics and stomach emptying may b de3layed for up to 12 hours. Opiates are reported to shorten labor, and correct in co-ordinate uterine action. But the mechanism appears to be the relief of pain and anxiety rather than any direction action of the uterine muscle.

                Placental transfer of all the opiates takes place rapidly and equilibration between maternal and fetal blood is completed within a short time. The effects of ethidine on the fetus that can be demonstrated in utero are a decrease in beat-to-beat variability on the cadiotocograph and altered fetal electroencephalogram. The neonatal effects of maternal opiates are a decrease Apgar score, a prolonged time to achieve regular respiration, lower oxygen saturation, decreased minute volume, hypercapnia and abnormal neurobehavioural scores. All these effects are related and can persist in the neonate for several days since the half-life of the opiates in the neonate is four to five times longer than that in the adult.

 Opiate effects and side effects can all be antagonized by naloxone –a pure opiate antagonist. There is no purpose in giving any combination of opiate plus antagonist to the mother in pain, as all the actions, including the analgesic action, will be reserved. If the mother has received opiates in labor naloxone should be given to those neonates who are depressed and do not breathe following initial resuscitation.

General Anesthetic Drugs Used during Labor –Effects on the baby

General Anesthetic Drugs  –Effects on the baby

Neonatal drug depression is minimized by keeping drug dosage levels low in the mother and by keeping the induction delivery interval as short as possible. Avoiding aortocaval compression, hypotension or hypoxia in the mother ensures that the infant is not hypoxic.

                Maternal safety during general anesthesia remains unpredictable. The danger of inhalation of stomach contents, especially in patients undergoing emergency cesarean section, continues to be a significant cause of maternal death. For this reason conduction anesthesia for surgical delivery of patients in labor is gaining popularity. However, general anesthesia remains essential for a small number of obstetric patients.

                The intravenous induction agents that are in widespread use in obstetric anesthesia, thiopentone, methohexitone and althesin, cross placenta so rapidly that it is not possible to deliver the baby before some quantity of the drug has been transferred; detectable levels occur within 30 seconds of an intravenous dose. However, the newborn appears not to be affected with these levels since the drugs, after crossing the placenta from the umbilical vein, pass through the fetal liver where some is metabolized. /the drug level in the infant’s brain is further lowered by dilution with less contaminated blood from the fetal legs and abdomen. The drug concentration very rapidly declines in the mother after a single dose as the drug I redistributed throughout her circulation. This ensures that the level continues to fall in the fetus.

                Volatile anesthetic agents are generally added to the inspired mixture to ensure maternal unawareness. The halogenated agents, halothanes, methoxyflurane and enflurane allow the mother a 50% oxygen proportion in the inspired air and may improve uterine blood flow. These agents do not increase postpartum uterine bleeding unless used in very high doses. They do not depress the newborn.

                Muscle relaxants cross the placenta in clinically insignificant amounts; succinyl choline I very rapidly metabolized by the pseudocholinesterase in the mother’s plasma. The non-depolarizing. Longer acting relaxants are very large molecules that are highly ionized and so are unable to cross the placenta.

                Nitrous oxide used intermittently or continuously for pain relief in normal labor does not cause maternal cardiovascular depression or alters uterine contractility, and it is safe for the fetus in concentrations of up to 50% in inspired air. However, nitrous oxide ad oxygen, when used alone for cesarean section without supplementary inhalational agents, has resulted in neonatal depression. This is possibly caused by decrease uterine perfusion following high endogenous catecholamine levels that are associated with this very light anesthesia.

                The premixed cylinders of 50% nitrous oxide and oxygen have been shown to give considerable analgesia. But timing of administrations is not easy when they are used intermittently, and thus analgesia is less efficacious than continuously inhaled self- administered nitrous oxide.