Pregnancy
NOW WHAT??
There are 3 trimesters; 1st 2nd 3rd
1st
Months 1 to 3 or 12 weeks
What your body will be doing:
Changes in Your Body
During the first three months of pregnancy, or the first trimester, your body undergoes many changes. As your body adjusts to the growing baby, you may have nausea, fatigue, backaches, mood swings, and stress. These things are all normal.
Most of these discomforts will go away as your pregnancy progresses. And some women might not feel any discomfort at all! If you have been pregnant before, you might feel differently this time around. Just as each woman is different, so is each pregnancy.
As your body changes, you might need to make changes to your normal, everyday routine. Here are some of the most common changes or symptoms you might experience in the first trimester:
Tiredness
Many women find they're exhausted in the first trimester. Don't worry, this is normal! This is your body's way of telling you that you need more rest. After all, your body is working very hard to develop a whole new life.
Try these tips to ease exhaustion:
- Get at least eight hours of sleep every night, and a nap during the day when possible.
- When you are tired, rest or relax.
- Start sleeping on your left side. This will relieve pressure on major blood vessels that supply oxygen and nutrients to the fetus. If you have high blood pressure during pregnancy, it is even more important to be on your left side when you are lying down.
- If you feel stressed, try to find a way to relax.
Nausea and Vomiting
Usually called "morning sickness," nausea and vomiting are common during early pregnancy. For many women, though, it isn't limited to just the morning. Although it can seem like it will last forever, nausea and vomiting usually go away after the first trimester.
Try these tips to help prevent and soothe nausea:
- Eat frequent, small meals (6 to 8 small meals a day) rather than 3 large meals. Avoid fatty, fried, or spicy foods.
- Try eating starchy snacks, like toast, saltines, cheerios, or other dry cereals when you feel nauseated. Keep some by your bed and eat something before you get out of bed in the morning. If you feel nauseous in the middle of the night, reach for these starchy foods. It's also a good idea to keep these snacks with you at all times, in case of nausea.
- Try drinking carbonated drinks like ginger ale or seltzer water in between meals.
- Ask your doctor if you should change prenatal vitamins if it seems to be making your nausea worse. Sometimes taking your prenatal vitamin at a different time (e.g. at night not in the morning) can also help.
- Ask your doctor about taking vitamin B6 for nausea and vomiting that doesn't get better with dietary changes.
If you think you might be vomiting excessively, call your doctor. If you lose too much fluid you might become dehydrated. Dehydration can be dangerous for you and your baby.
For some women, the nausea of the first trimester is so severe that they become malnourished and dehydrated. These women may have a condition called hyperemesis gravidarum (HG). HG refers to women who are constantly nauseated and/or vomit several times everyday for the first 3 or 4 months of pregnant.
HG keeps pregnant women from drinking enough fluids and eating enough food to stay healthy. Many women with HG lose more than 5 percent of their pre-pregnancy weight, have nutritional problems, and have problems with the balance of electrolytes in their bodies. The persistent nausea and vomiting also makes going to work or doing other daily tasks very difficult.
Many women with HG have to be hospitalized so they can be fed fluids and nutrients through a tube in their veins. Usually, women with HG begin to feel better by the 20th week of pregnancy. But some women vomit and feel nauseated throughout all three trimesters. Visit the Hyperemesis Education and Research (HER) Foundation Web Site for more detailed information on HG.
Frequency of Urination
Running to the bathroom all the time? Early in pregnancy, the growing uterus presses on your bladder. This causes frequent urination.
See your doctor right away if you notice pain, burning, pus or blood in your urine. You might have a urinary tract infection that needs treatment.
Weight gain
During the first trimester, it is normal to gain only a small amount of weight, about one pound per month.
Changes in Your Baby
By the end of the first trimester, your baby is about three inches long and weighs about half an ounce. The eyes move closer together into their positions, and the ears also are in position. The liver is making bile, and the kidneys are secreting urine into the bladder. Even though you can't feel your baby move yet, your baby will move inside you in response to pushing on your abdomen.
Doctors Visits
During the early months of pregnancy, regular doctor visits (prenatal care) are especially important. Become a partner with your doctor to manage your care. Keep all of your appointments — every one is important!
During the first prenatal visit, you can expect your doctor or nurse to do the following:
- ask about your health history including diseases, operations, or prior pregnancies
- ask about your family's health history
- do a complete physical exam
- do a pelvic exam with a Pap test
- order lab tests
- check your blood pressure, urine, and weight
- figure out your expected due date
- answer your questions
Get more details on prenatal care.
1st Trimester Tests and Procedures
For special genetic or medical reasons, you may need other lab tests, like blood or urine tests, cultures for infections, or ultrasound exams in the first trimester. Your doctor will discuss them with you during your visits.
The most common tests recommended in the first trimester include:
Nuchal translucency screening (NTS)
This new type of screening can be done between 11 and 14 weeks of pregnancy. It uses an ultrasound and blood test to calculate the risk of some birth defects. Doctors use the ultrasound exam to check the thickness of the back of the fetus' neck. They also test your blood for levels of a protein called pregnancy-associated plasma protein and a hormone called human chorionic gonadotropin (hCG). Doctors use this information to tell if the fetus has a normal or greater than normal chance of having some birth defects.
In an important recent study, NTS found 87% of cases of Down syndrome when done at 11 weeks of pregnancy. When NTS was followed by another blood test done in the second trimester ( maternal serum screening test), 95% of fetuses with Down syndrome were identified.
Like all screening tests, the results are sometimes misleading. In 5% of women who have NTS, results show that their babies have a high risk of having a birth defect when they are actually healthy. This is called a false positive. To find out for sure if the fetus has a birth defect, NTS must be followed by a diagnostic test like chorionic villus sampling or amniocentesis .
NTS is not yet widely used. If you are interested in NTS, talk to your doctor. If she is unable to do the test, she can refer you to someone who can. You should also call your insurance company to find out if they cover the cost of this procedure. NTS allows women to find out early if there are potential health problems with the fetus. This may help them decide whether to have follow-up tests.
Chorionic villus sampling (CVS)
CVS is performed between 10 and 12 weeks of pregnancy. In CVS, the doctor inserts a needle through the abdomen or inserts a catheter through the cervix to reach the placenta. The doctor then takes a sample of cells from the placenta. Experts use this sample to look for problems with the baby's chromosomes. This test cannot find out whether your baby has open neural tube defects. About 1 in 200 women have a miscarriage as a result of this test.
What your baby will be doing:
All the organs will develop, as well as senses. Very Critical time.
2nd
Months 4 to 7
Changes in Your Body
Most women find the second trimester of pregnancy easier than the first. But it is just as important to stay informed about your pregnancy during these months.
You might notice that symptoms like nausea and fatigue are going away. But other new, more noticeable changes to your body are now happening. Your abdomen will expand as you gain weight and the baby continues to grow. And before this trimester is over, you will feel your baby beginning to move!
Many of the aches and pains you had in the first trimester may continue. So remember to follow the tips from Pregnancy Basics to help prevent and ease these discomforts.
Some of the following aches and pains may make their first appearance during the second trimester:
- Pain in the abdomen, groin, and thighs
- Backaches
- Shortness of breath
- Stretch Marks
- Skin Changes
- Tingling in hands and fingers
- Itching on the abdomen, palms, and soles of the feet — Call your doctor if you have nausea, loss of appetite, vomiting, jaundice or fatigue combined with itching. These can be signs of a serious liver problem called cholestasis of pregnancy.
Weight Gain
Everyone gains weight at different rates. On average, it is normal to gain about one pound per week, or about three to four pounds per month during this trimester.
Changes in Your Baby
By the end of the second trimester your baby will weigh about 1 3/4 pounds and be about 13 inches long. With this growth comes the development of fingers, toes, eyelashes, and eyebrows. Around the fifth month, you might feel your baby move! By the end of this trimester, all of your baby's essential organs like the heart, lungs, and kidneys are formed.
2nd Trimester Tests and Procedures
During the second trimester, you should continue to see your doctor for prenatal care. Most pregnant women have monthly office visits with their doctor or midwife until the end of this trimester.
During the second trimester your doctor can use an ultrasound to see if your baby is developing in a healthy way and to find out your baby's sex. You will also be offered screening tests to look for genetic birth defects.
Birth defects result from problems with a baby's genes, inherited factors that are passed down from the mother and the father at conception. Genetic birth defects sometimes occur in people with no family history of that disorder. Women over the age of 35 have the greatest chances of having a baby with birth defects.
Some of the diagnostic and screening tests your doctor might suggest in the second trimester include:
Amniocentesis
This test is performed in pregnancies of at least 16 weeks. It involves your doctor inserting a thin needle through your abdomen, into your uterus, and into the amniotic sac to take out a small amount of amniotic fluid for testing. The cells from the fluid are grown in a lab to look for problems with chromosomes. The fluid also can be tested for AFP. About 1 in 200 women have a miscarriage as a result of this test.
Chorionic villus sampling (CVS)
This test is performed between 10 and 12 weeks of pregnancy. The doctor inserts a needle through your abdomen or inserts a catheter through your cervix in order to reach the placenta. Your doctor then takes a sample of cells from the placenta. These cells are used in a lab to look for problems with chromosomes. This test cannot find out whether your baby has open neural tube defects. About 1 in 200 women have a miscarriage as a result of this test.
Maternal serum screening test
This blood test can be called by many different names including multiple marker screening test, triple test, quad screen, and others. This test is usually given between 15 and 20 weeks of pregnancy. It checks for birth defects such as Down syndrome, trisomy 18, or open neural tube defects. Doctors take a sample of your blood. They check the blood for 3 chemicals: alpha-fetoprotein (AFP) (made by the liver of the fetus), and two pregnancy hormones: estriol and human chorionic gonadotropin (hCG). Sometimes, doctors test for a fourth substance in the blood called inhibin-A. Testing for inhibin-A may improve the ability to detect fetuses with a high risk of Down syndrome.
Higher levels of AFP are linked with open neural tube defects. In women age 35 and over, this test finds about 80% of fetuses with Down syndrome, trisomy 18, or an open neural tube defect. In this age group, there is a false positive rate (having a positive result without actually having a fetus with one of these health problems) of 22%. In women under age 35, this test finds about 65% of fetuses with Down syndrome, and there is a false positive rate of about 5%.
Targeted ultrasound
The best time to get a targeted ultrasound is between 18 and 20 weeks of pregnancy. Most major problems with the way your baby is formed can be seen at this time. Some physical defects such as clubbed feet and heart defects may not be seen.
Your doctor can also use ultrasound to see if your baby has any neural tube defects, such as spina bifida. In most cases, if you want to find out the sex of your baby, you can ask your doctor during this test. This is not the most accurate test for Down syndrome. Only 1 in 3 babies with Down syndrome have an abnormal second trimester ultrasound.
3rd
Months 8 to birth
3rd Trimester
The third trimester of pregnancy generally spans weeks 28 through 40, although healthy babies may be born a bit sooner or later. As the birth approaches, you will probably feel a combination of excitement and a desire to hurry things along. As you are now carrying around quite a lot of extra weight, you will experience a number of symptoms related to your increasing size. By now your uterus (which used to weigh about two ounces) holds your baby, the placenta, and up to two pounds of amniotic fluid, so it is little wonder that you may feel a bit uncomfortable.
During this trimester, it’s time to prepare for labor. Have your labor and hospital bag ready to go and finish your birth plan (be sure both your health care provider and the place where you are delivering have a copy of your plan). Also, should you want an experienced labor support person to be present at your baby’s birth, now is the time to contact a doula.
Usually around week 29, your health care provider will change the schedule of your prenatal visits from monthly to every two weeks. After week 36, your prenatal visits will be scheduled once every week until delivery. Toward the later weeks of your pregnancy (approximately the 38th week), a pelvic examination will be performed to determine the degree of dilation and effacement your cervix. Your health care provider may also ask if you’ve experienced Braxton Hicks contractions, discuss the symptoms of preterm labor with you, and answer any questions regarding labor and delivery procedures.
The third trimester is also the right time to plan ahead for life with your baby. For instance, you’ll need to choose a pediatrician or family practice physician for your little one. Many doctors offer a “get acquainted” office visit before the birth; this is a chance to form a working relationship with someone who will become an important part of your lives. And be sure to check with your insurance plan to ensure the physician’s services are covered.
During these last months you’ll also need to finish paperwork related to your maternity leave, discuss when (or if) you’ll be returning to work with your employers, and find adequate childcare. Daycare centers usually have waiting lists and if you’re in the prospects for a nanny, you’ll want enough time to interview candidates.
The purchase of baby essentials is recommended now so that you can focus on your baby and your own postpartum recovery after the birth.
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Third Trimester Hemoglobin and Hematocrit (H&H) 28–32 weeks What it measures. These tests check for anemia in the last part of the pregnancy. Some practices do a regular CBC blood draw, while others use a finger stick hemoglobin test. What it tells you. It is normal for pregnant women to have a drop in their H&H around 28 weeks in their pregnancies. If the H&H have dropped lower than expected, iron supplementation and possibly more tests before and at the time of labor will be suggested. Fetal Fibronectin (fFN) Testing What it measures.
Fetal fibronectin (fFN) is a biochemical marker used as a predictor for the risk of preterm delivery. The presence of fetal fibronectin in the cervical or vaginal secretions is highly correlated with preterm labor.
The test involves placing a simple swab briefly at the back of the vagina, behind the cervix. It is then sent to a lab where the sample is checked for the presence or absence of fetal fibronectin.
It is used when a mother may be having, or be at risk for, premature labor. Not a routine test, it may be performed between 24 and 35 weeks when a woman is having regular contractions or her cervix is softening, shortening, or opening too soon in the pregnancy.
It may also be used between 22 and 30 weeks as a screening test for women with multiples or premature rupture of membranes, or those with a history of a previous preterm delivery.
What it tells you.
Fetal fibronectin testing is new. It is used both for women with symptoms and for women who have risk factors for possible preterm labor or delivery.
If the fFN test is negative it is considered to have a predictive value of 99.2% in women with symptoms. Thus, a negative result reassures both mother and provider that the baby will not be born in the next two weeks. The test’s positive predictive value is significantly less accurate. A positive test is considered to be accurate only about 16.7% of the time in predicting that the baby will be born early (i.e., in the next two weeks).Vaginal bleeding and/or recent intercourse will cause a false positive test.
This test is also often used in conjunction with a special kind of ultrasound called trans-vaginal ultrasound (TVUS), in which a small probe is placed in the vagina to measure the thickness and length of the cervix. The practitioner can do a manual check of the cervix to determine if it is open or closed, and its length in the vagina. The TVUS can actually get a picture of the portion of the cervix one cannot feel on exam. The combination of a negative fFN test and a normal TVUS are very reassuring.
Since the test is only predictive for a two-week time period, someone with continued symptoms or risk factors may have repeat tests at two-week intervals.
Links:
DUE DATE CALCULATOR:
http://www.realsavvymoms.com/pregnancy/article.php?category2=8&article=49
PREGNANCY TIMELINE:
http://www.realsavvymoms.com/pregnancy/article.php?category2=8&article=47
PREGNANCY CALENDAR:
