Requirement of iron during pregnancy

Iron is a very important nutrient during pregnancy.Anaemia is the most common nutrient-related abnormality of pregnancy and is attributable to iron deficiency which is in turn caused by folate deficiency.Beacuse of the cessation of menses,iron requirement drop during first trimester.dEmands increase during the second trimester and then reaches its peak during third trimester at 4 mg per day.Pregnancy consumes about 1040 mg of iron in total,of which 200 mg is recaptured after pregnancy from the expanded red cell mass.The iron is lost to the foetus(300 mg),the placenta(50 to 75 mg),expanded red cell mass(450 mg) and blood loss at partituition(200 mg).Pregnancy enhances absorption of iron by 30%.An intake between 13 and 40 mg per day is required during the third trimester.Multivitamin/multimineral supplements contain 30 mg of iron and the diet provides an additional 15 mg.In case of iron deficiency anemia during pregnancy increased intake to replenish bone marrow stores and still provide for the metabolic needs of the foetus.In such situations daily iron intake will be between 120 and 150 mg.Iron supplementation should continue postpartum both to provide iron for breast milk and to replenish losses due to bleeding at delivery.

Normal labour - Stages of labour - Normal delivery

Normal labour takes place in three different stages..

First stage of labour:

The first stage of labour starts from the onset of true labour pain and ends with full dilatation of the cervix.Its average duration is about 12 hours in primigravidae and 6 hours in multiparae.First stage consists of latent phase(up to 3 cm of cervical dilatation) and active phase(up to 10 cm).The stage is concerned with dilatation and effacement of the cervix.The atge is clinically manifested by progressiveuterine contraction,dilatation and effacement of the cervix and ultimate rupture of the membranes.Maternal and fetal conditions remain unaffected except during uterine contraction.

Management consists of :

1.Non interference with watchful expectancy.

2.Woman is given encouragement,emotional support and adequate pain relief during entire course of labour.

3.To monitor carefully the progress of labour,maternal condition and fetal behaviour so as to detect any deviation from the normal.

Second stage of labour:

The second stage of labour starts from full dilatation of the cervix and ends with the expulsion of fetus.Its average duration is 2 hours in primigravidae and 30 minutes in multiparae.The stage concerns with the descent and delivery of the fetus through the birth canal.The stage is clinically manifested by increased frequency and intensity of uterine contractions with appearance of bearing down efforts which result in the expulsion of fetus.The mother may show signs of exhaustion.

The principles in management are:

1.To assist in the natural expulsion of the fetus slowly and steadily.

2.To prevent perineal injuries.

During the conduction of delivery,head is delivered slowly in between contractions.Flexion is maintained all through so that the smaller diameter of the hea stretches the perineum.This along with timely episiotomy(selective) prevents perineal laceration.Shoulders are delivered slowly with the next contraction.

Immediate care of the new born includes clearing of the air passage and eyes,clamping and ligaturing of the umbilical cord and Apgar scoring.

Third stage of labour:

The third stage of labour begins after the expulsion of the foetus and ends with the expulsion of the placenta and membranes.Its average duration is 15 minutes.The stage concerns with the placental seperation and its expulsion.The seperation is achieved by marked reduction in the uterine surface area of the placental site following delivery due to retraction.The placenta being inelastic shears off its attachment through the deep spongy decidual layer.There are two ways of seperation – central and marginal.The bleeding is controlled by effective myometrial contraction and retraction and by thrombosis.The expulsion may occur through bearing down with asssistance.The management is either by employing watchful expectancy or by active management in cases where oxytocin 10 units IV or IM/methergin 0.2 mg IV is adminstered within one minute following the delivery of the baby.The placenta and the membranes should be examined following their expulsion.

Diet during pregnancy

Diet during pregnancy should be adequate to provide:

1.good maternal health.

2.optimum fetal growth.

3.The strength and vitality required during labour.

4.Successful lactation.

During pregnancy there is increased calorie requirement due to increased growth of the maternal tissues,foetus,placenta and increased basal metabolic rate.The diet in pregnancy should be with the woman’s choice as regard the quantity and the type..Woman with normal BMI should eat adequately so as to gain the optimum weight(11 kg).Overweight women with BMI between 26 to 29 should limit weight gain to 7 kg and obese women(BMI greater than 29) should gain less weight.Excessive weight gain increases antepartum and intrapartum complications including fetal macrosomia.

Pregnancy diet should be light,nutritious,easily digestible and rich in protein,minerals and vitamins.The diet should consist in addition to the principal food at least half litre,if not,1 litre of milk as 1 litre of milk contains about 1 gm of calcium,plenty of green vegetables and fruits.The amount of salt should be of sufficient amount to make thefood  tasty.Half of the total protein should contain all the aminoacids and majority of the fat should be animal type which contains vitamins A and D.

Nausea and vomiting during pregnancy - Morning sickness during pregnancy

Nausea and vomiting(morning sickness) during pregnancy specially in the morning,soon after getting out of bed are usually common in primigravidae.They usually appear following the first or second missed period and subside by the end of the first trimester.50% of the women have both nausea and vomiting,25% suffer from only nausea and only 25% remain unaffected.

Three main measure taken during early pregnancy can reduce morning sickness,They are

1.Take dry roast,biscuits and protein rich meals.

2.Frequent small foods are helpful.

3.Fatty foods are to be avoided.

4.Avoid personal triggering factors.

5.Medications can be taken but only under medical supervision.

Backache during pregnancy

Backache is a common problem during pregnancy.Physiological changes that contribute to backache are joint ligament laxity(relaxin,oestrogen),weight gain,hyprlordosis and anterior tilt of the pelvis.Other factors may be faulty posture and high heel shoes,muscular spasm,urinary infection or constipation.Excessive weight gain should be avoided.Rest with elevation of the legs to flex the hips may be helpful.Improvement of the posture,well fitted pelvic girdle belt which corrects the lumbar lordosis during walking and rest in hard bed often relieve the symptom.Massaging the backmuscles,analgesics and rest relieve the pain due to muscle spasm

Leg cramps during pregnancy

Leg cramps during pregnancy may be due to deficiency of diffusable serum calcium or elevation of serum phosphorus.Supplementary calcium therapy in tablet or syrup after the principal meals may be effective.Massaging the leg,application of local heat and vitamin B1(30 gms) daily may be effective.

Constipation during pregnancy

Constipation is quite a common problem during pregnancy.Atonicity of the gut due to the effect of progesterone,diminished physical activity and pressure of the gravid uterus on the pelvic colon are the possible reasons for the same.Regular bowel habit should be restored by regulation of the diet by taking plenty of fluids,vegetables and milk.Stool  softners can also be taken at bed time.Constipation must be avoided during pregnancy as it could lead to rectal bleeding,painful fissures or haemorrhoids due to hard stool..

Dark chocolate mousse

Dark chocolate mousse can be made easily with this recipe...

Ingredients:

Dark chocolate:230 gms

Cream anglaise:280 gms

Whipped cream:400 gms

Melt the chocolate at 45 degrees and warm cream anglaise and when the mix is at 25 degrees add the whipped cream..

Put this in the mould and place in freezer for 2 hours…

White chocolate mousse

White chocolate mousse - Learn to make white chocolate mousse with this simple recipe...

Ingredients:

White chocolate:230 gms

Coco butter:35 gms

Cream anglaise:210 gms

Whipped cream:410 grams

Melt the chocolate at 45 degrees and add the warm anglaise and when the mix is at 25 degrees add the whipped cream…

Put in the mould  and place in the freezer for 2 hours…

Milk Chocolate mousse

Milk Chocolate mousse - Learn how to make milk chocolate mousse with this simple recipe...

Milk chocolate:315 gms

Cream anglaise:210 gms

Whipped cream:350 gms

Mel the chocolate at 45 degrees and warm  cream anglaise and when the mix is at 25 degrees add the whipped cream…

Put in the mould and place in the freezer for 2 hours…

Cheese cake

Cheese cake - Yummy and delicious!!

Ingredients:

Digestive biscuits:600 gms

Butter:150 gms

Cream cheese:1800 gms

Sugar:300 gms

Eggs:600 gms

Melted butter:180 gms

Preparation:

Mix all the ingredients until smooth and bake in an oven at 145 dgerees C  for an hour…

Murgh malai tikka - Chicken tikka

Murgh malai tikka - This is a popular indian starter consisting of skewered cubes of boneless chicken cooked to tender perfection in a tandoor or clay oven..

Ingredients:

Boneless chicken cubes:1 kg

Yoghurt:20 gms

Processed cheese:50 gms

Salt to taste

Refined oil:10 ml

White pepper powder:3 gms

Cream:90 ml

Coriander:10 gms,chopped

Green chilly:10 gms,chopped

Cashew nut paste:20 gms

Green cardamom powder:3 gms

Mace powder:2 gms

Preparation:

In a bowl,rub the cheese till it is creamy…

Gradually incorporate the remaining ingredients to form a smooth coating marinate…

Squeeze out the excess moisture from the chicken and marinate in the prepared marinade…

Rub in well..

Refrigerate for atleast 2 hours…

Skewer and cook in tandoor or clay oven basting once..

Cook till well done..

Enjoy the murg malai tikka!!

Machchi patiala

Machchi patiala - This recipe comes from punjab in northern india and gets its name from the city of Patiala..This dish is cumin flavoured fillet of fish,deep fried and served with wedges of lime as a starter or side dish…

Ingredients:

Fish fillet:500 gms

Cumin seeds:2.5 gms

Gram flour:12 gms

Egg:1

Corn flour:5 gms

Red chilli powder:2.5 gms

Turmeric powder:1 gm

Lemon juice:3 ml

Refined oil:250 ml

Chaat masala:2 gms

Hing paste:2 ml(asafoetida)

Salt to taste

Preparation:

In a tray whisk the egg and then add the gram flour,corn flour,hing paste and lemon juice…

Mix well..

Add the remaining ingredients and prepare a batter…

Squeeze out the excess moisture from the fish and coat with the batter…

Leave the fish fillets in the refrigerator for two hours…

Deep fry the fish on a low fire until it turns golden brown…

Sprinkle chaat masala and serve hot!

Mamoul

Mamoul cane be made easily with this recipe...

Ingredients:

Flour:600 gms

Ghee:375 gms

Sugar syrup:250 ml

Date paste:500 gms

Ghee:50 gms

Cinnamon powder:7 gms

Dry yeast:3 gms

Preparation:

Prepare flour,yeast,ghee and sugar syrup…

Mix all the ingredients together and make a firm dough..

Let it rest for 1 hour…

Mix the date paste with the small amount of ghee(50 gms) and cinnamon powder..

Portion the dough in to small balls and stuff them with the date paste…

Place it on the baking tray and bake it at 300 degrees for 5 minutes…

Enjoy the mamoul dessert…

Pineapple mille-feuille

Pineapple mille-feuille is an easy to make simple dessert that looks very delicately done...

Ingredients:

Sliced pineapple:5 slices

Butter:100 gms

Sugar:100 gms

Brown sugar:100 gms

Orange juice:80 gms

Coffee:10 gms

Flour:70 gms

Preparation:

Dip the pineapple slices in coffe and drain…

Rub the rest of the ingredients and dry in the oven for 10 minutes…

Enjoy this simple yet delicate Pineapple mille-feuille!!