Samantha Ivy’s Mommy asked:


I am in my fifth month and I no strech marks yet and was wondering when do most women tend to get them during pregnancy? Thanks all!

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Ectopic is derived from Greek word ektopos, meaning out of place. Ectopic pregnancy was first discovered in the 11th century and by the end of 18th century, it took a lethal form. Many women were then known to die of ectopic pregnancy. Today, with advancements in the field of medicine, death due to ectopic pregnancy is rare. Nevertheless, an ectopic pregnancy can prove to be dangerous.

What Is An Ectopic Pregnancy?

Ectopic pregnancy is not a normal pregnancy. In normal pregnancy, the sperms reach the egg in the fallopian tube, where fertilization occurs and then, this fertilized egg travels on to reach the uterus and implants itself there to complete the gestation period. However, in ectopic pregnancy, the fertilized egg fails to reach the uterus for the gestation period and instead implant itself anywhere outside uterus, like cervix, fallopian tube, abdominal cavity. In general, in ectopic pregnancy cases, the fertilized egg implants itself in the fallopian tube.



Since in ectopic pregnancy, the embryo implants itself outside the uterus, it starts drawing blood for its growth, rupturing the organs and creating danger to life. As only the uterus is designed to hold the fetus, so ectopic pregnancy does not last for more than 3 months. It always results in the death of the embryo.

Symptoms For Ecotopic Pregnancy

There are symptoms that help in deducing the ectopic pregnancy. Although it is also not necessary that all these pregnancy symptoms will be seen. Lower abdominal pain, which increases over a period, accompanied by lower back pain, Shoulder pain, which occurs, as the fetus draws blood for its growth, hampers the functions of diaphragm. Vaginal bleeding, which is different from normal bleeding, can be heavier or lighter and the blood is dark colored. Nausea and vomiting, Weakness, and pale skin, followed by fainting (caused because of bleeding), Low blood pressure when the bleeding is heavy.

Causes Of Ecotopic Pregnancy



Several major factors cause ectopic pregnancies. Some of them are listed below:

Previously, if the woman had undergone any fallopian tube surgery Occurrence of several abortions. If there had been an ectopic pregnancy earlier. Intake of medicine for stimulating the process of ovulation

Smoking

Increase of age; increase in age results in the loss of tubular mobility, due to lack of myoelectrical activity. Infections in fallopian tube and uterus.



Remedy For Ectopic Pregnancy



If the ectopic pregnancy is at initial stage then it can be destroyed by a drug methotrexate, which has very minimum side effects. At advanced level, it can only be treated with the help of surgery, in which the pregnancy will be removed.

After-effects Of Ectopic Preganancy

Due to doses of methotrexate, there will be a little nausea, vomiting, and dizziness.

When the surgery is actually performed at advanced level, there might be a decrease in the womans fertility. You must know that your pregnancy is normal or not. You will know the early signs of pregnancy if you monitor your pregnancy week by week. If you find anything unusual, see a doctor at once.



By: Apurva Shree

About the Author:

A molar pregnancy refers to a pregnancy which is a type of gestational trophoblastic disease. The molar pregnancies are also called gestational trophoblastic disease (GTD). It may refer to a part or all of a mole. A molar pregnancy is a mass of abnormal tissue (hydatiform mole), which comes from inside of the uterus, placenta, triggering symptoms of pregnancy. It occurs when there is a problem with the embryo as a result of ***** and egg. A molar pregnancy is a pregnancy complication that occurs in 1 out of 1000 pregnancies in the United Kingdom A molar pregnancy can develop during the first stage of pregnancy.

When an egg abnormal genetic information is fertilized by a *****. The sperm’s chromosomes in duplicate and develop a mole. A normal fertilized egg by two *****. This cell mass is most likely to develop into a partial mole. Age greater than 40 years is a risk factor for molar pregnancy, as is a preview pregnancy. Early on Molar, a molar pregnancy is associated with symptoms similar to that of a normal pregnancy, including morning sickness, fatigue and *******. However, the symptoms begin to appear around the tenth week of pregnancy, and may include nausea and vomiting and vaginal bleeding.

Other symptoms of abdominal pain or cramps, high blood pressure (premature, pre-eclampsia), cough (rarely, coughing blood), and no movement or fetal heartbeat. Treatment of recurring molar pregnancy, called gestational trophoblastic neoplasia, or GTN, in medical terms, generally composed of a chemotherapy drug called methotrexate. Support groups and counseling can be beneficial. An ectopic pregnancy often have to be surgically removed. When an ectopic pregnancy is diagnosed before rupture of the fallopian tube, the provider usually makes a small incision in the fallopian tube and removes the embryo, the preservation of the fallopian tube.

Molar Pregnancy Treatment and Prevention Tips

1. Using a D&C under general anesthesia.

2. Support groups and counseling can be beneficial.

3. Pregnancy should be avoided for one year after a molar pregnancy.

4. Any birth control method is acceptable with the exception of an intrauterine device.

5. Pelvic ultrasound may be used during the procedure to guide removal of all the abnormal tissue.



By: Juliet Cohen

About the Author:

Cervical alterations during pregnancy in Small Ruminants

 

P. Goswami and G. M. Wani

Directorate of Extension Education,

SKUAST-K, Shalimar Srinagar

 

 

The cervix uteri is a thick walled fibromascular tube connecting the body of the uterus and ******. It a muscular organ composed of connective tissues predominantly elastic fibres. In the non pregnant ewes, the cervical canal is impassable except during oestrous. Five or six hard prominences within the canal assist the sphincter effect of the cervix (Nickel, Schummer & Seiferle, 1973). During the course of gestration, the length of cervix increases and in late pregnancy the wall becomes thicker, with an overall increase in the compliances of the tissues (Cloete, 1939; Abusineina, 1969). This may be related to disaggregation of densely packed collagen fibre in the cervix of pre-partum ewe. This paper will focus some of the important physical and microscopical changes occurred in the cervix of small ruminants during pregnancy

 

Anatomy of the cervix:

The cervix separates the uterus from the ******. During pregnancy, it seals and protects the embryo and fetus from the external environment. The gross and microscopic anatomy of the cervix has been studied by various workers. The casts of the inside of the cervical lumen shows its convulated structure consisting five to six circular folds and the second fold being eccentric  to the other concentric folds and acting as physiological barrier. The cervical fold in small ruminants varies from five to six folds. In cow four large circular and 15-25 longitudinal primary folds each with many secondary and tertiary folds are present. Cervical mucosa is generally characterized by longitudinal primary fold and most of which maintained continuity throughout the cervix.  Superimposed on these secondary folds which is varied in length and depth. Abundant shallow uniformity and parallel longitudinal grooves covers all surface.

 

 

Morphological changes in the cervix:

Three major changes generally observe in cervix during pregnancy. These are described as growth (physical increase in length and breadth). Softening (changes in tensile properties) and dilation to allow passage of the foetus. The study carried out by different workers showed that ovine cervix shows an increase in width and length in the later stages of pregnancy. The analysis of the constituency of cervices shows increase softening from the mid pregnancy and there after firmness of cervix losses.

A small increase in the degree of hydration of the cervix or dry weight at different gestrational stages has been reported by Fosang et. al. (1994), ward 1968. This may be due to increased tissue mass rather than increase in size of water content. However some author reported no significant changes/differences in water content of the cervices from non pregnant to pregnant animals. The physical chemical and histological properties of cervix are constant throughout the length of cervix. However, Basset (1958) reported morphological changes in the fibroblast of the broad and sacro-iliac ligament by the 60th day of pregnancy but this information is not supported on ultrastructural studies.

 

Light Microscopical changes: 

Morphologically the most prominent feature of non pregnant cervix is heavy, densely packed collagen fibre interspersed with fibroblast (fig.3 ). Small blood vessels are present throughout the depth of the tissue, but most numerous in deepest layer. Smooth muscle bundle are running both longitudinally and transversely in the middle and deeper layer. The figure represents a wall of non pregnant cervix. The lining epithelium is low columnar and secrets neutral  mucin. The sub epithelial connective tissue is vascular and contains variety of cells including eosinophil, macrophages, mast cells and plasma cells. The greater proportion of cervical wall is composed of dense fibrous connective tissue consisting of compactly arranged collagen fibre with some fibrocytes and occasional fibroblast embeds in sparse ground substance. The individually arranged smooth muscle fibre forms an incomplete muscularies of which the outer fibre is longer and more prominent than inner fibre. The electron microscopically the collagen fibre shows very compact in arrangement and the scarcity of the ground substance and the presence of fibrocytes. Fosang et. al . opined that there is no significant changes observe between proximal, middle and distal portion of cervix irrespective of stain used. The best stain normally use for differentiation between collagen fibre and the smooth muscle bundle are Massons’ Trichrome stain, where the alignment of the collagen fibre along with villi shows projecting towards lumen. In general collagen fibre are large and closely spaced and are organized either longitudinally or obliquely. Section stained with Toludine Blue stain revels metachromatic staining along the collagen fibrils with strong staining of epithelial cells associated mucus. The morphological changes donot become apparent until quite late in the gestration period. The description of non pregnant cervix applied equally to the connective tissues observed in the early stages of pregnancy even to 100 days.  

                                                             

Fig. Pregnant cervix showing

      

Fig: Dense Collagen fibre, inner circular & longitudinal muscular layer with epithelium H&E 4X

Fig. Central cervix Transverse section Loosening of epithelium and collagens layer H&E  (pregnant)

 

 

 

 

 

The histological section at 100 days of pregnancy revels no virtually distinguish alteration from that of non pregnant cervix (Calder et. al).  The tall columnar cervical epitheliums are the only changes represents in pregnancy and the secretions are a mixture of acid and neutral mucin. Acidity increases with the pregnancy age. Tissue breakdown and destruction of collagen networks is evident at 140 days of pregnancy. The cells are more widely spaced (empty area) and the collagen fibre losing their organization exposing smooth muscle cells. This can be best seen with Massons’ Trichrome. The infiltrating cell at this stage are lymphocytes and monocytes and few eosinophils. In late gestration increased fibroblast activity, smooth muscle hypertrophy, vascular edema and dissolution of collagen fibre bundle are reported by various worker. These findings contrasted with the rigid fibromuscular tissue observe in the non pregnant animals. The appearance of thinner fibre and empty areas between fibres in late pregnancy is lead to decrease concentrations of hydroxyproline in tissue. Collagen fibre dissolution in pregnant cervix has been extensively reported in several species and many authors have reported that active collagenolysis occurring during pregnancy may be the underlying mechanism of cervical softening. Ellowed et al (1981) have shown that ovine cervical explants produce both latent and active collagenase activity, with greater yields of activity in parturient tissue compared with the late pregnancy after 3-5 days in culture. Inflammatory cells invading cervix towards late gestration provide a potential source of collagenase and neutral protinease activity. Eosinophils also have been described as potential bearer of specific collagenase which may be responsible for collagen catabolism (Basset, 1972). At the term the disruption of collagen fibre are more even pronounced with virtually no large fibre remaining. In Haematoxyline & Eosin stain sectioned it sometimes appears very little or no collagen at all. But very little and small fibrils arranging random pattern are seen in Massons’ Trichrome stains. In this stage there is heavy infiltration of inflammatory cells among which eosinophils predominant. An area of haemorrhage is also a constant finding along with infiltrating cells. In late pregnancy there is complete network of subepithelial capillaries with a marked increase in the size of the vessels in the outer part of the cervical wall.

 

Ultrastructure feature:

Ultrastructuraly, non pregnant cervix reveals the typical dense connective tissue with collagen aggravated in closely packed fascicles and fibrocytes embedded in sparse ground substance. The ultrastructural characteristic in late pregnancy are presence of rough endoplasmic reticulum, mitochondria,plasmalemmal vesicle and extensive branching of individual fibres in contrast to the absence of these feature in muscle fibres of the non-pregnant cervix. This description is also similar to early pregnancy stage. The ultrastructural analyses of the cervical connective tissue reflects active changes in tissues, with a reorganization of the cervix prior to the functional changes at parturition.

 

 

 

Changes in collagen concentration:

The biochemical analysis of hydroxyproline in tissue can be used for collagen concentrations. Study carried out by Regassa et al. (1983) shows the total collagen content of cervix at all stages of pregnancy is significantly greater than that of caruncular mean and the intercaruncular areas. The concentration of hydroxyproline is not changed in cervix during Ist trimester of pregnancy. However the concentration of hydroxyproline progressively decreases at days 100, 140 days and in post partum tissues as compared to the non pregnant tissue(Fosang et. al 1984). The concentration is same between proximal, middle or distal region of the pregnant and non pregnant cervix.

In conclusion it is summarized that uterine cervix of small ruminants became softer during the pregnancy and that some associated changes first appear in early gestartion. There is no significant changes in water content through pregnancy although light increases is associated with cervical size and softening of the tissue. Physical and histological properties are identical in all section along the length of cervix. The changes associated with increasing length of gestration are absolute increase in width and length, relative increases in fibroblasts, smooth muscle and softening; relative decreases in collagen and fibrocytes. But increased vascularisation without any white cell infiltration of the tissue is specifically associated with late gestration.

 

 

REFERENCES

Abusineina M.E. (1969) Effect of pregnancy on the dimendions and weight of the cervix uteri of sheep. British Vet. J 125, 21-24

 

Amanda J. Fosang, Christopher J. H. Vivien S., Dennis A. L. and Geoffery D. T. (1984) pregnancy related changes in connective tissue of ovine cervix. Biology of reproduction 30, 1223-1225

 

Aughey, E, Munro, C. D., Calder, A. A., Coutts, J R. T. & Fleming, R (1981). The histology and ultrastructure of the pregnant sheep cervix uteri. J. of Anatomy 132, 448

 

Basset, E. G. (1958) Gestational changes in connective tissue. Nature 181, 196-197

 

Cloete, J.H.L. (1939) prenatal growth in the merino sheep onderstepoort journal  of veterinary science & animal industry 13, 417-543

 

Calder A.A., Aughey E. Coutts J. Fleming R and Munors C.(1983) Changes pattern of cervix on pregnancy J. Anat (1983) 136, 2 389-399

 

Ellwood D.A., Anderson, ABM, Mitchell and Turnbill A.C. (1981) Prostanoids, collagenase and cervical softening in sheep. Am. J. Obst. Gyneol. 10:281-287

 

Hollingsworth, M. (1981) Softening of rat cervix during pregnancy. In the cervix in pregnancy and labour- clinical and biochemical investigations (ed. D. A. Ellwood & A.B.M. Anderson) pp.13-33 Edinburg

 

K. June Mullins, R. G. Saacke (1988) Study of the functional anatomy of bovine cervical mucosa with special reference to mucus secretion and ***** transport Journal of Reproduction and Fertility (1979) 57 261-266

  

Karen Sohan , Rebecca Wiggins and Peter Soothill (1999), Cervical Physiology in pregnancy and labour. Foetal and Maternal Medicine review 11: 135-141 Cambridge

 

 More J (1984) Anatomy and Histology of the cervix uteri of ewe: A new insight Acta. Anat (basal) 120 (3). 156-9

 

Nickel, R., Schummer A. & Seiferle E., (1981) The viscera of domestic animals pp.358 and 361 berlin verlag Paul Pavey.

 

Regassa F. and Noakes D. E.(1983) Changes in the weight, collagen concentration and content of the uterus and cervix of ewe during pregnancy. J Biology 73, 221-25

 

 



By: Dr. Pankaj Goswami

About the Author:

A weekly pregnancy calendar is a manual that records the journey of the fetus from conception to birth. It expounds in detail, the pregnancy week by week development that the fetus should achieve in the mother womb. The pregnancy calendar also gives the details about the changes that occur in the mother body and tells how to cope with these changes. This information can help the would-be-mother to ascertain that the fetus is growing in a healthy manner and her pregnancy is safe. Hence, every mother-to-be must possess a pregnancy week by week calendar to keep track of the milestones that the growing fetus achieves every week. Nowadays, there are numerous websites from where you can download these pregnancy calendars for free.

A Look At The Pregnancy Calendar

A weekly pregnancy calendar generally follows a forty week schedule. The calculation of the calendar is very simple. The LMP i.e. the last menstrual period date is the first day of the pregnancy calendar. Forty weeks from the date is the due date. Here, it has to be noted that only in very few cases, the baby is delivered on the due date. Generally any day after the 37th week is safe, because the baby would have attained full development by the 37th week.

A pregnancy calendar generally makes the following information available.

1. The growth and development that the fetus must achieve in each week of pregnancy,

2. The physical and the emotional changes that the mother-to-be undergoes and coping with these changes,

3. Nutritional requirements and exercises for a health pregnancy,

4. The do and do not during the nine months.

In a nutshell, a weekly pregnancy calendar is an excellent reference guide for every anxious would-be mother. It helps her to understand every change and emotion that she would be undergoing through the forty weeks of the pregnancy wheel. It helps her to keep track of what is going on in her womb every minute. The calendar helps in alleviating her anxiety and comforts her.

Maintaining Your Own Weekly Pregnancy Calendar

You can also make your own pregnancy calendar. It is very simple. Once you know your LMP and due date, you can yourself start maintaining the physical and emotional changes that you undergo on a weekly basis. You can compare this with any standard pregnancy calendar to assure yourself that everything is well.

Advantages Of Maintaining Your Own Pregnancy Calendar

In addition to the above mentioned benefits, maintaining your own weekly pregnancy calendar has some apparent advantages.

1. You can use the calendar as a jotting notepad to record your queries, doubts and apprehensions. This will be useful in future appointments with your doctor.

2. The pregnancy calendar is particularly useful in the third trimester of pregnancy (week 26 to week 40). In this final trimester, there are many changes happening in the mother body. The would-be mother will then find the pregnancy calendar handy. With the help of a good calendar, she can identify if her contraction are true or false and if there is a need to consult the doctor.

3. A religiously written pregnancy calendar will be very useful for the doctor in case any emergency arises in the course of delivery.

4. You can use your weekly pregnancy calendar to understand your future pregnancies better.



By: Apurva Shree

About the Author: