I Am Already Pregnant, What To Do!

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Congratulations! I wish you a pregnancy filled with happiness and health!

How do we know if we are really pregnant? Once your expected menstrual period is delayed, wait a few days or even a week, and do ahome  pregnancy test from your nearest pharmacy. These tests indicate whether you are pregnant with high percent accuracy. You should see two well-visible bars on the test to be positive. If one is visible and the other line is faint, it is good to repeat the test after 2-3 days. If you can not wait to find out, you can do a blood test and examine a hormone that is rising during pregnancy called beta-hCG. It is best for the blood test to be interpreted by an obstetrician-gynecologist.

Once you are pregnant, planned or not, you need to think about some things. One of the first things you should do is visit an obstetrician-gynecologist. The examination should not be too early and not too late. What do I mean? If you have a gynecological examiniation when your menstration is only 2-days late, the examiniation will not establish anything essential. The ultrasound may show a little embryo sac or it may not be visualized. On the other hand, if you visit your doctor after 3-4 months of pregnancy, you will miss the important tests that needed to be done, and you may not have known to take a folic acid supplement. Pregnant women need to take 400 micrograms of folic acid a day for the first 12-14 weeks of gestation to prevent neural tube defects. My advice is to visit your obstetrician-gynecologist after at least 2 to 4 weeks delay of the menstrual period.

At the doctor’s visit, you will talk about the current pregnancy, previous pregnancies, illnesses, any surgeries you may have undergone, and other health related questions. It’s important to be open and share all the information you have. If you think there is something that upsets you and you do not want to share it with your relatives or partner, make an appointment with your doctor for a time when you are alone. Keep in mind that even small details may prove to be essential. Do not conceal facts and do not worry about sharing everything that is important or may cause you to be concerned.

A gynecologist’s visit includes an examination. The gynecological examination is very important for us to detect the presence of various pathological conditions that can not be detected by ultrasound alone. For example, a cervical polyp can cause a lot of worry if it is not identified because it may begin to bleed and if medications are prescribed that are not beneficial and you can bleed as a result. A genital infection without an examination and a microbiological examination can not be identified and treated, and it can cause premature birth. The gynecological examination focuses on your anatomical and physiological features – the condition of the external genital organs, the vagina, the cervix, the uterus, the ovaries, the pelvis. You should know that gynecological examination is not dangerous for you or for pregnancy – it only brings positives. I understand that women have concerns about the discomfort of it, but I do not think that this should be so worrying. I have always appreciated the concern of the patients and I have been as careful as possible with every woman. During the gynecological examination, it is important to evaluate the cervix, uterus and adnexi, thus making it possible to assess whether the pregnancy is uterine or ectopic!!!

An ultrasound should be made to provide additional information on the presence or absence of pregnancy, its location and its duration. A view of the woman’s reproductive system as well as the small pelvis is made. Ulstrasonic images can be a very informative method when done by a well-trained specialist. Here I would like to add that there are many courses in ultrasound training both in Bulgaria and around the world – but only in the United Kingdom, the USA, Canada, and Australia there are several Fetal Medicine Subspecialization Centers, where the experts from this field come from. In the UK, this subspecialization lasts for 2 years and is conducted under the guidance of Professor Kypros Nikolaides at King’s Collage Hospital in London, University Collage Hospital in London, The Fetal Medicine Center in London. You can find information about all graduates there by country on the following website: http://fetalmedicine.org/diploma-in-fetal-medicine.

In some cases, testing of beta-hCG (human chorionic gonadotropin) may be necessary to confirm or reject the presence of pregnancy, to track how it develops. In case of doubt about an ectopic pregnancy, it may be necessary to monitor this indicator every other day. I advise you to do the test only in the same laboratory if it is to be tracked because this will minimize the variations in the results of the different laboratories.

At the beginning of your pregnancy, your gynecologist will want you to do routine blood and urine tests if you do not have any illness that requires follow-up and further examinations. Blood tests will include the following: Blood group and Rhesus factor of the partners – there is a condition in which if the mother has a negative rhesus factor and the father has a positive factor, in case of another pregnancy there is a risk of complications of the fetus if anti-D gammaglobulin prevention has not been made during the first pregnancy; CBC (complete blood count) – generally indicates the presence or absence of anemia and infection; glucose or blood sugar – which increases in the case of diabetes; AST and ALT – hepatic enzymes, indicate whether there is liver damage; bilirubin – it is of two types, we judge it for hepatic function and for hemolytic anemias; urea and creatinine – shows kidney function; Toxoplasmosis IgM and IgG – parasites that damage the fetus are transmitted from animal, primarily from cats and dogs, so avoid contact with animals during pregnancy, especially at the beginning; Hepatitis B and Hepatitis C – infectious diseases that can lead to severe liver disorders; AIDS – an infectious syndrome in which the immune system is suppressed and the body has reduced resistance to infections and neoplasms in the body; Syphilis – an infectious disease leading to severe damage to the nervous system in the diseased, and causing severe damage to the whole body of the fetus, if left untreated. All of these diseases are transmitted to the fetus in the womb or during labour.

Urine is also tested for the presence of sugar, protein, sediment, increased bilirubin products, bacteria, and so on.

Considering the fact that at the beginning of pregnancy, the organs of the fetus have been developed, you have to protect youself from many viral and bacterial diseases. Even a slight runny nose for you can be very dangerous for the fetus depending on the cause. Influenza and rubella are viral diseases that cause severe embryo or fetal damages and can lead to abortion or loss of the fetus. This does not mean ‘to never poke your nose out of the house’, but if you work in a large team or meet with many people be cautious and watch out for epidemics. If you work in a kindergarten, a school or a hospital where you can meet many sick people carrying infections, think about whether you can change your position or take sick leave. Working with a large team in a confined space creates a real risk of rapid transmission of airborne infections. In such situations, it is good to wear a mask over the  mouth and nose – masks have a limited protection time of no more than 3 hours. So you’ll need to put on a new mask every 3 hours to have effective protection. Another precaution is good personal hygiene, washing hands before and after a visit to the toilet, before eating and so on. Do not exchange personal belongings with other people, including food items, lipsticks, makeup – any items that you get in close contact with.

Smoking is extremely damaging to you and your pregnancy. That is why I am personally very opposed to pregnant women smoking. Alcohol also causes damage to the fetus and should be avoided. See ‘Before I Get Pregnant’ for more information.

Pregnancy is not a disease but a physiological condition, so it does not restrict you from fulfilling your daily duties. Of course, when certain conditions occur, restrictions may be imposed, but this is only when there are problems during pregnancy. If you have no problems you can work, exercise, have sex, and so on. See ‘Before I Get Pregnant’ for more information.

Work during pregnancy does not endanger, in a large percentage of the cases, you or the fetus. There are, of course, exceptions that you should take into consideration. If you work with chemicals, fuels, radiation or medications you can breathe, check what risks you may have. If there are any injuries at your workplace, read Art. 309 of the Labour Code and consult with a lawyer to decide how to proceed.

Long journeys to and from the workplace with the presence of vibrations are risk factors and should be avoided. Keep the time for work and rest, I know it’s difficult nowadays  but you’re pregnant so take advantage of the sympathy of your colleagues.

Sports and pregnancy are compatible, but not in the case of professional sports. If you are an athlete, work out only for pleasure –  not for results. Of course towards the end of the pregnancy, you will have mobility limitations, but you can still do light exercises to maintain the tone of your muscles. According to Prof. Nicolaides, the bed regimen in pregnant women, even with a risk pregnancy of premature delivery, is much more harmful. According to him, lying in bed for a long time leads to stress, muscular atrophy, reduced venous blood flow and thrombosis risk. Decreased physical activity also leads to weight gain. Even 4-5km of walking will help keep you trim and give you energy.

Create healthy habits everyday that include physical activity, healthy eating, denial of harmful habits, and very important – a positive attitude.

Sex! Do not deprive one another. In a normal pregnancy, you should not limit yourself or your partner. Sex has a lot of positives –it creates a sense of delight, tones you as it can be part of your physical exercise, emotionally brings you closer to the future dad and reduces tension and stress. A fully consumed relationship is evident, and vice versa. I would advise that when you are having sex and are pregnant, to not get into any strange poses, not to be rude, but more careful. If you want passion, change the place, time, play roles, but be more kind and careful. Do not strive to get an orgasm every time, on the contrary. Orgasm leads to the release of oxytocin from the hypothalamus that causes contraction of the uterus, which should not be stimulated frequently. This does not mean you are not aiming for an orgasm at all. Have them, but a little less. It is very important to note that hygiene is essential. Take care of infections in the vagina. Infections can cause premature birth by prematurely opening the amniotic fluid that could endanger the fetus.

When you are pregnant, sex becomes a bit more difficult and slow. This should not disturb you. It is important to enjoy it. Find the right postures for you. Often, the practiced posture is laterally, or the woman is with her back to the man and leans forward. By the end of pregnancy, I would not recommend men ejaculating in a pregnant woman’s vagina. The semen contains prostaglandins that can cause contractions.


Center for Fetal Medicine

Get informed about the world of Fetal Medicine with Dr. Boris Stoilov.

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