Are you ready for that big event?

In most homes where there is a baby or an elderly person, certain measures are taken for easy contactability in case of an emergency. Neighbours are requested to be watchful and phone numbers of someone who can get home within a few minutes pasted on the wall.

Such an “emergency plan” is essential when there is an expectant mother at home, stresses Prof. Harsha Seneviratne, Dean of the Colombo Medical Faculty, pointing out that “planning and preparation” should start even before the pregnancy.

“It must be a wanted and planned pregnancy,” points out Prof. Seneviratne detailing the different stages as: Pre-pregnancy, Early pregnancy, Mid-pregnancy, Delivery and Post-delivery. A file should be opened and past records of medical conditions included systematically in date order.

Pre-pregnancy preparation – being a “wanted” pregnancy, the preparations should start before the wife gets pregnant, with her nutrition and health status being checked out including important risk factors related to familial (the possibility of diabetes) and other medical conditions (heart and kidney disease).

Another detail that needs to be verified is whether she has been vaccinated against diseases such as Rubella (German measles).

This is due to the serious consequences if she contracts Rubella while she is pregnant – with the unborn baby being vulnerable to congenital rubella which in turn will cause serious physical and mental deformities.

Look at the environment that the mother-to-be is living in, advises Prof. Seneviratne. Is there pollution of some kind? Is she exposed to toxic substances or living in a chemically-polluted environment?

Of utmost importance, MediScene understands, will be past maternity details including problems during earlier pregnancies, labour and delivery, details of the babies’ birth weights, whether they have been live births and issues faced during the first six weeks after delivery.

These must be included in the file as they are of tremendous value to the team providing care during the pregnancy. “This information speaks a lot and will help the doctors to predict what may happen and be prepared,” says Prof. Seneviratne, suggesting that the midwife in the area who knows your family set-up could always be called upon for advice.

An appropriate clinical examination complements the details obtained from the history and clinical interview. As prior heart disease causes significant problems during pregnancy examination of the pulse, blood pressure and checking the heart using a stethoscope is of utmost importance.

This is also an opportunity to perform even more detailed examination depending on the condition of each patient. Basic tests such as urine examination and blood sugar could be done under the advice of the area Medical Officer of Health, your family doctor or any other designated care provider, it is learnt.

Early pregnancy – Bleeding through the birth canal or unusual and persistent abdominal pain are the danger signals to watch out for.

If the expectant mother experiences one or both these symptoms of a significant severity, it is crucial for her to be brought to the nearest hospital for assessment, MediScene learns. If there is fever or severe vomiting or both, Prof. Seneviratne stresses that it is important to bring the fever down by taking paracetamol in the right doses at the stipulated time intervals.

Dealing with the common belief among Sri Lankans that during pregnancy one should not take even one paracetamol tablet, he points out that if the expectant mother has fever, it needs to be brought down. Otherwise the unborn baby in her womb will be as if in an “oven” due to the mother’s temperature and suffer harm. If the fever persists beyond two days, the mother should be taken to hospital.

In the case of severe vomiting, relatives should ensure that the mother maintains a proper fluid intake, giving her liquids like Jeevani, even a spoonful at a time, to prevent dehydration and seek medical attention if the vomiting persists.

Meanwhile, if there are any other troublesome and persistent symptoms, it is advisable to seek support from the local hospital or field Medical Officer or even your family doctor.

Mid-pregnancy – Dribbling or bleeding from the vagina becomes more significant as the pregnancy advances and needs immediate assessment and treatment.

Unusually severe and continuous abdominal pain also needs checking out, according to Prof. Seneviratne, even though some of the causes may be harmless. If the expectant mother experiences breathlessness and palpitations, get her screened, while fever and severe vomiting would also require attention.

Late pregnancy and delivery (28 weeks to delivery) – Urgent and immediate attention is a must if dribbling or bleeding through the birth canal or unusual abdominal pain occurs. Another important factor to keep in mind is the unborn baby’s movements.

If the baby’s movements reduce and remain reduced or absent a check up in hospital is mandatory, says Prof. Seneviratne. When there is bleeding or abdominal pain, defer giving food or drink to the expectant mother till assessed at the hospital because she may have to undergo emergency surgery. is another point to remember. Breathlessness and palpitations etc. should also be checked.(repeated?)

Post-delivery – Bleeding within the first month of delivery, if it is more than a heavy period, fever, however mild, severe abdominal pain require immediate medical attention.

It is vital to avoid the “first delay” whenever there is such a situation, MediScene understands, as it could lead to the domino effect and result in serious harm to the baby even ending in death. Someone must be on hand to bring the expectant mother for emergency care, says Prof. Seneviratne, explaining that it should not be that the patient should await the husband’s return from work to come to hospital. It may be too late then. A means of transport to the closest hospital should be planned from early pregnancy and arranged well ahead of time.

In Sri Lanka, many couples plan meticulously about which hospital they would go for the delivery. They don’t plan or discuss where they will go in an emergency.

“This will be the hospital closest to your home,” says Prof. Seneviratne, explaining that the health-care network, from the midwife to the mother and child clinic to the rural hospital to the base hospital to the general hospital to the teaching hospital is well organized in Sri Lanka.

The public should use the maternity care system to its maximum capacity so as to ensure safety for the mother and her baby.

With almost all expectant mothers, laudably registering early (within the first three months) in the health-care system, it will be good if they request their doctor for a plan of management, it is learnt.

Then the doctor could study their previous health records and current health status and give them guidelines for the management of their pregnancy, says Prof. Seneviratne.

Citing an example, he says if a mother has had a large baby previously, a diabetic chart could be maintained from 28 weeks of the current pregnancy to avoid complications.

If earlier babies have been small, well planned ultrasound scan examinations on pre decided times in the pregnancy should be done to monitor the unborn baby’s weight and the mother advised on her diet.

Over the years, MediScene has been at the forefront of highlighting crucial and relevant health issues to its readers who include not only lay people but also all those involved in the medical field. New findings, solutions to old issues, pioneering treatment or trailblazing operations have been spread across the pages of MediScene, the Sunday Times monthly magazine devoted to healthy living.

Our April issue of MediScene is dedicated to all those women out there who form nearly 51% of this country’s population and are the pivots around whom their families revolve. The dedication “for women’s health” is for the 8th South Asia Federation of Obstetrics and Gynaecology Conference 2011 and the 44th Annual Scientific Sessions of the Sri Lanka College of Obstetricians and Gynaecologists now on at the Cinnamon Grand Hotel, Colombo.