Pregnancy

Pregnancy is certainly a special time in a woman’s life, eliciting an abundance of joy and excitement . However, if it’s a new experience for you, it’s only natural that you would have questions about your health and that of your baby.

Pregnancy support

What’s the first step to taking charge of your pregnancy? In Canada and Quebec, you can count on accessible and reliable information. All provincial public health programs in Canada provide support to pregnant women from the first trimester to the last, as well as after childbirth:

• Your health care professional can determine the stage of your pregnancy and is your most reliable point of contact for all the information you need to make the right decisions.
• The Public Health Agency of Canada provides a practical guide about all aspects and stages of your pregnancy which you can download from its website.
• The Institut national de santé publique du Québec offers its own guide: From Tiny Tot to Toddler.

The first trimester (14 weeks): The first organs of the embryo appear (head, torso, arms and legs) and at 14 weeks, it measures about 9 centimetres.

During the first month of your pregnancy, you may feel very tired and have an irresistible desire to sleep. The following symptoms may appear:

• Swollen and painful breasts
• Morning sickness (sometimes lasting during the day)

Second month of pregnancy

Significant hormonal changes:

• Adrenaline (feeling stressed or restless)
• Endorphins (feeling of well-being)
• Estrogen (feeling of excitement)
• Progesterone (sedative effect)

Third month of pregnancy

The symptoms you experienced at the beginning of your pregnancy (such as nausea and vomiting, fatigue, tight and painful breasts) begin to disappear.

Your baby’s presence seems more real to you due to its growth. You begin to feel its movements for the first time. At the end of the second trimester, the fetus measures about 25 cm from head to coccyx and weighs about one kilogram.

Insomnia
You may suffer from insomnia, perhaps because you’re concerned about your health and that of your baby (e.g. Will my baby be normal and healthy?).

What’s more, during this trimester, you need to undergo tests to determine whether your baby has any anatomical or physiological abnormalities (e.g. Down syndrome, gestational diabetes, toxoplasmosis, ultrasound screening for fetal malformations). All these tests can contribute to increasing your anxiety.

Good sleep hygiene can help you sleep better :

• Have a light meal in the evening.
• Avoid drinking coffee or tea.
• Sleep in a dark, quiet, relaxing room.
• Read before going to sleep.
• Take a hot bath before bedtime to help you relax.

Your baby will soon be born and is now alert, reacting to stimuli such as outside noises and caresses on your belly. Its lungs will continue to develop, enabling it to breathe easily at birth.

How to decide if it’s time to give birth

The onset of childbirth is characterized by the following:

• Loss of the mucus plug blocking the cervix and the appearance of mucus and blood
• Intensifying contractions: hardening of the belly for a few seconds, accompanied by contractions that are more constant and gradually increase (longer, stronger, closer together and more painful)
• The amniotic sac surrounding the baby ruptures (i.e. your water breaks)

Certain signs indicate that your pregnancy could be high-risk:

Hypertension

In some women, hypertension only occurs during pregnancy. You’re at risk if you already have high blood pressure, had high blood pressure during a previous pregnancy, or are expecting twins.

Diabetes during pregnancy

Diabetes during pregnancy is called “gestational diabetes.” This disorder is caused by an increase in your blood sugar level, which is tied to the production of certain hormones by the placenta. Gestational diabetes poses no risk of malformation for your baby and one of its most frequent consequences is a larger than average baby, which can lead to a difficult delivery. It can also cause diabetes and breathing problems in your baby at birth.

Twins: A high-risk pregnancy

Giving birth to twins is considered high-risk. This type of pregnancy is monitored more intensely and subject to more medical tests and appointments with a health care professional.

A twin pregnancy often leads to the following issues:

• Possibility of premature babies because childbirth may begin before term
• Twin-to-twin transfusion syndrome: For identical twins, abnormalities may occur if blood from the same placenta is not evenly distributed.
• Second baby: At birth, the second baby may have umbilical cord complications, placenta problems or an abnormal presentation .

Late pregnancy

A late pregnancy is also considered high-risk. If you’re over 40 , you and your baby are ten times more likely to have complications, which may include the following:

• Gestational diabetes
• High blood pressure and pre-eclampsia, especially if advanced age is combined with obesity and/or smoking
• Placenta previa
• Cesarean section
• Hemorrhage during childbirth
• Chromosomal abnormalities, including Down syndrome (the risk is estimated at 1 in 1,500 births for mothers who are 20 years old, 1 in 1,000 at age 30, 1 in 400 at age 35, 1 in 187 at age 38 and 1 in 100 at age 40. The risk of Patau syndrome and Edwards syndrome also increases with maternal age.).
• Birth defects: From 3.5% at age 25, the prevalence climbs to 5% at age 40.
• Intrauterine growth restriction (IUGR)
• Neonatal mortality

Early pregnancy – Blood test to check your immunity to certain diseases (e.g. German measles, STBBIs)

Week 10 – Ultrasound to establish the date of conception and facilitate the calculation of the estimated date of delivery (EDD). It’s worth noting that not all ultrasound scans offered to you during your pregnancy are mandatory.

Weeks 9 to 14 – Nucal translucency (thin translucent space between the muscles and skin of the fetal neck)

Weeks 10 to 13 – Screening test for Down syndrome. There are two options: The first consists of two blood tests (another will be performed between weeks 14 and 16) and can detect the risk of Down syndrome. The second option involves providing a blood sample from the 10th week onwards. An analysis is made of the genetic material in your blood in order to assess the risk of Down syndrome, Patau syndrome and Edwards syndrome, among others. These tests do not determine whether the baby has a disease or not. If the risk of a trisomy disorder is high, a diagnostic test will be recommended (e.g. amniocentesis).

Weeks 11 to 13 – Chorial biopsy: This diagnostic test involves taking a biopsy of the placenta using a thin needle inserted into your abdomen. It can detect certain genetic abnormalities in your baby and is recommended when the risk of such abnormalities is high. The risk of a miscarriage associated with this biopsy is 1% (1 in 100).

Beginning at week 15 – Amniocentesis: This test involves removing a small amount of fluid from the amniotic sac (i.e. a few millilitres) using a thin needle inserted into your abdomen. It can reveal genetic abnormalities (such as a trisomy disorder) in your baby. Amniocentesis is especially recommended for expectant mothers over the age of 35 and for those at particular risk. The risk of miscarriage associated with this procedure is between 0.25% and 0.5% (1 in 400 to 1 in 200).

Weeks 18 to 22 – Ultrasound to see whether your baby is developing well

Weeks 24 to 28 – Blood test to determine whether you have gestational diabetes

Weeks 34 to 37 – Group B streptococcus test (quick, painless vaginal swab)

An ectopic pregnancy, which affects 2% of all pregnancies, occurs when a fertilized egg implants itself outside the uterus instead of its natural place (in the uterus). It is one of the major causes of maternal mortality.

Possible causes and risk factors associated with an ectopic pregnancy

You are at greater risk of having an ectopic pregnancy if you have had a tubal ligation that was unsuccessful, have a history of ectopic pregnancy, or have had an infection or surgery in the pelvic region.

Wearing an IUD (especially one containing estrogen) and taking a birth control pill that contains only progesterone are also more likely to result in an ectopic pregnancy.

Symptoms

An ectopic pregnancy is manifested by irregular vaginal bleeding and abdominal cramps. This bleeding is caused by a fertilized egg that develops and tears the walls of the Fallopian tube (often between six to eight weeks after the last menstrual period).

This bleeding can cause a drop in blood pressure and symptoms associated with shock (pallor, excessive sweating and fainting). The risks to the mother’s health increase wit a more advanced ectopic pregnancy,

Treatments

If your uterus does not expand during pregnancy, your health care professional will want to determine whether the pregnancy is ectopic. An ultrasound will be prescribed to reveal whether the uterus is empty and determine where the fetus has become implanted. Once located, the fetus will be removed by administering a medication such as methotrexate, or by laparoscopy.

Laparoscopy involves inserting a thin tube into the abdominal cavity. The tube is equipped with a camera and surgical instruments. If an egg has developed in the Fallopian tube, the latter will have to be cut and allowed to heal naturally (even with only one Fallopian tube, you can become pregnant again).

In early pregnancy, minor bleeding that is not serious may occur. However, at every stage of your pregnancy, we recommend that you talk to your health care professional. Bleeding in early pregnancy can be explained in a number of ways, including:

• Nidation – When the egg attaches itself to the endometrium (uterine lining ) about 7-8 days after fertilization, minimal, benign bleeding may occur.
• Ectopic pregnancy (lien vers la grossesse ectopique ci-dessus)
• Miscarriage – A spontaneous termination of a pregnancy, often leading to symptoms such as blood loss accompanied by lower abdominal pain
• Decidual hematoma and partial placental abruption (detachment) – During the nidation process, the placenta may detach and cause a hematoma that disappears spontaneously. If it gradually worsens, it can cause a miscarriage.
• Molar pregnancy – This complication is caused by a chromosomal abnormality. It is very rare and characterized by an abnormal development of the placenta and the absence of an embryo. In general, a molar pregnancy is manifested by internal bleeding that increases the volume of the uterus and amplifies the signs of pregnancy. It can also cause a spontaneous miscarriage.

Bleeding in late pregnancy

• A retroplacental hematoma occurs when the placenta detaches over a large area and causes a hematoma between the uterine wall and placenta. Considered a medical emergency, it must be treated by Cesarean section.
• Placenta previa is a placenta that is considered to be implanted too low. The contractions in late pregnancy can cause placental abruption (detachment) and bleeding. You will need complete rest until the end of your pregnancy and have to undergo a Cesarean section.

The physical changes that accompany pregnancy often have major consequences on the quality and quantity of your sleep. They may also increase your risk of developing obstructive sleep apnea or restless leg syndrome, especially in the last trimester.

Sleep apnea during pregnancy can cause complications such as the following:

• Pregnancy-induced hypertension
• Pre-eclampsia
• Intrauterine growth restriction
• Gestational diabetes

If you suffer from insomnia or disturbed sleep during your pregnancy, talk to your health care professional.

When you need professional support, we're here to help.

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