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Week 15 How Big Is Your Baby? The fetal crown-to-rump length by this week of pregnancy is 4.1 to 4.5 inches (93 to 103mm). The fetus weighs about 1.75 ounces (50g). It's close to the size of a softball. How Big Are You? You can easily tell you're pregnant by the changes in your lower abdomen, which alter the way your clothes fit. You may be able to feel your uterus about 3 or 4 inches (7.6 to 10cm) below your bellybutton (also called the umbilicus or navel). Pregnancy may not be obvious to other people when you wear regular street clothes. But it may become obvious if you start wearing maternity clothes or put on a swimming suit. It's still a little early to feel movement, although you should feel your baby move in the next few weeks! How Your Baby Is Growing and Developing Your baby's rapid growth continues. Its skin is very thin. Blood vessels can be seen through the skin at this point in its development. Fine hair called lanugo hair covers the baby's body. By this time, your baby may be sucking its thumb. This has been seen with ultrasound examination. Eyes continue to move to the front of the face but are still widely separated. Ears continue to develop externally. As you can see in the illustration on page 132, they now look more like normal ears. In fact, your baby looks more human all the time. Bones already formed are getting harder and retaining calcium (ossifying) very rapidly. If an X-ray were performed at this time, the baby's skeleton would be visible. Triple-Screen Test Tests are now available that go beyond alpha-fetoprotein testing in helping your healthcare provider determine if you might be carrying a child with Down syndrome. With the triple-screen test, your alpha-fetoprotein level is checked, along with the amounts of human chorionic gonadotropin (HCG; a pregnancy hormone) and unconjugated estriol (a form of estrogen produced by the placenta). The levels of these three chemicals in your blood may indicate the presence of Down syndrome. For older mothers, the detection rate of the problem is higher than 60%, with a false-positive rate of nearly 25%. If you have an abnormal result with a triple-screen test, an ultrasound and amniocentesis are usually recommended. Changes in You Pap Smear during Pregnancy During your first visit to your doctor, you probably had a Pap smear. A Pap smear is usually done at the beginning of pregnancy. By now, the result is back, and you have discussed it with your doctor, particularly if it was abnormal.
The Pap smear (short for Papanicolaou smear) is a screening test done at the time of a pelvic exam. It identifies cancerous or precancerous cells coming from the cervix, which is located at the top of the vagina. This test has contributed to a significant decrease in mortality from cervical cancer because of early detection and treatment. An Abnormal Pap Smear If you have had an abnormal Pap smear or have been treated for an abnormal Pap test, continue to get checked as your doctor suggests. Pap smears are screening tests. If a test is abnormal, findings must be verified and treatment decided upon by your doctor. If you are not pregnant, most doctors will suggest a biopsy of the cervix if your Pap smear is abnormal. An abnormal Pap smear during pregnancy must be handled individually. When abnormal cells are ônot too badö (premalignant or not as serious), it may be possible to watch them during pregnancy with colposcopy or Pap smears; biopsies are not usually done at this time. The cervix bleeds easily during pregnancy because of changes in circulation. This situation must be handled very carefully. When Is a Biopsy Necessary? A biopsy of the cervix is done in your doctor's office, without anesthesia, with colposcopy. Colposcopy is a procedure that uses an instrument similar to a pair of binoculars or a microscope to look at the cervix. This enables your doctor to see where abnormal areas are so biopsies can be taken. Most obstetricians/gynecologists are able to do this procedure without sending you to a specialist. A biopsy provides a better idea of the nature and extent of the problem. If there is a possibility that abnormal cells could spread to other parts of the body, a cone biopsy may need to be done. A cone biopsy precisely determines the extent of more severe disease and removes abnormal tissue. This surgery is done with anesthesia but is not usually performed during pregnancy. Treating Abnormal Cells There are several ways to treat abnormal cells on the cervix, but most treatment methods cannot be performed during pregnancy. These treatments include surgically removing the abnormal spot (if it can be seen), electric cautery to remove or ôburnö small abnormal spots, cryocautery to freeze small lesions, laser treatment to destroy abnormal areas on the cervix and cone biopsy for more-involved lesions. How Your Actions Affect Your Baby's Development Genetic Counseling For some couples, genetic counseling may be important. If you have reasons to be concerned, genetic counseling can help you make informed decisions about childbearing. Couples who may be advised to seek genetic counseling include those who have already had an infant with problems, those with a family history of inherited diseases, women who have had recurrent miscarriages (usually three or more), any woman whose age will be 35 or more at the time of birth or if you are married to a relative. Questions asked may include things about both partners' family histories of Down syndrome, spina bifida, hemophilia and muscular dystrophy. If either partner is black, screening for the sickle-cell trait may be suggested. If both partners are descended from Ashkenazi Jews, they may be tested to see if they are carriers of the trait for Tay-Sachs disease. If genetic counseling is recommended for you and your partner, you will meet with a group of counselors. Data is gathered by these specially trained healthcare professionals. Information is then interpreted and used by you and your partner to help you make decisions about childbearing.
You Should also Know Pregnancy After 30 Today, many women are waiting until they have worked awhile and established a career before they get married and start their families. Older women who give birth have a slightly higher risk of abnormalities and problems, including premature labor, pelvic pressure and pelvic pain. For a detailed discussion of pregnancy in the older woman, read my book Your Pregnancy After 30. An older pregnant woman may be more likely to face increased risks of: ò a baby born with Down syndrome ò high blood pressure ò Cesarean delivery ò multiple births ò pre-eclampsia ò placental abruption ò bleeding and other complications It's also harder to be pregnant when you're older. Chances are you have a job or other children making demands on your time. You may find it harder to rest, exercise and eat right. Down Syndrome Until a woman is 30 years old, her chance of giving birth to a baby with Down syndrome is less than 1 in 800. It increases to 1 in 100 by the age of 40 and 1 in 32 by age 45. Although the actual number of pregnancies affected by Down syndrome is higher, many of these pregnancies end in miscarriage or stillbirth. The risk of giving birth to a Down syndrome infant, according to the mother's-to-be age, is shown in the table on page 136. However, this risk can also be looked at in a different way. At age 40, a woman still has less than a 1% chance of having a baby with Down syndrome. At 49, that risk is still fairly low; a woman has a 93% chance of having a normal baby. Down syndrome is the most common chromosomal defect detected by amniocentesis. (See Week 17 for more information about amniocentesis.) If you are concerned about the risk of Down syndrome because of your age or family history, discuss it with your doctor.
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