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Week 22 How Big Is Your Baby? Your baby now weighs about 12.25 ounces (350g). Crown-to-rump length at this time is about 7.6 inches (19cm). How Big Are You? Your uterus is now about 0.8 inch (2cm) above your bellybutton or almost 9 inches (22cm) from the pubic symphysis. You may feel ôcomfortably pregnant.ö Your enlarging abdomen is not too large and doesn't get in your way very much. You're still able to bend over and to sit comfortably. Walking shouldn't be an effort. Morning sickness has probably passed, and you're feeling pretty good. It's kind of fun being pregnant now! How Your Baby Is Growing and Developing Your baby continues to grow; its body is getting larger every day. As you can see by looking at the illustration on page 185, your baby's eyelids and even the eyebrows are developed. Fingernails can also be seen. Liver Function Your baby's organ systems are becoming specialized for their particular functions. Consider the liver. The function of the fetal liver is different from that of an adult. Enzymes (chemicals) are made in an adult liver that are important in various body functions. In the fetus, these enzymes are present but in lower levels than those present after birth. An important function of the liver is the breakdown and handling of bilirubin. Bilirubin is produced by blood cells. The life span of a fetal red blood cell is shorter than that of an adult. Because of this, more bilirubin is produced by the fetus than by an adult. The fetal liver has a limited capacity to convert bilirubin and to remove it from the fetal bloodstream. Bilirubin passes from fetal blood through the placenta to your blood. Your liver helps get rid of fetal bilirubin. If a baby is born prematurely, it may have trouble processing bilirubin because the liver is too immature to get rid of bilirubin from the bloodstream by itself. A newborn baby with high bilirubin may exhibit jaundice. A baby with jaundice has a yellow tint to the skin and eyes. Jaundice is usually treated with phototherapy. Phototherapy uses light that penetrates the skin and destroys the bilirubin. Jaundice in a newborn is typically triggered by the transition from bilirubin being handled by the mother's system to the baby handling it on its own. The baby's liver can't keep up. Jaundice is more likely to occur in an immature infant when the liver is not ready to take over this function.
Changes in You Fetal Fibronectin In some cases, normal discomforts of pregnancy, such as lower-abdominal pain, dull backache, pelvic pressure, uterine contractions (with or without pain), cramping and a change in vaginal discharge may be confused with preterm labor. Until now, we have not had a reliable method of determining if a woman was truly at risk of delivering a preterm baby. A test is now available that can help doctors make this determination. Fetal fibronectin (fFN) is a protein found in the amniotic sac and fetal membranes. However, after 22 weeks of pregnancy, fFN is not normally present until term. When it is present in the cervical-vaginal secretions of a pregnant woman after 22 weeks, it indicates increased risk for preterm delivery. If it is absent, risk of premature labor is low and the woman probably won't deliver within the next 2 weeks. The test is performed like a Pap smear. A swab of vaginal secretions is taken from the top of the vagina, behind the cervix. It is sent to the lab, and results are available within 24 hours. Anemia in Pregnancy Anemia is a common problem during pregnancy. If you suffer from anemia, treatment is important to you and your baby. If you are anemic, you won't feel well during pregnancy. You'll tire easily. You may experience dizziness. There is a fine balance in your body between the production of blood cells that carry oxygen to the rest of your body and destruction of these cells. Anemia is the condition in which the number of red blood cells is low. If you are anemic, you have an inadequate number of red blood cells. During pregnancy, the number of red blood cells in your bloodstream increases. The amount of plasma (the liquid part of the blood) also increases but at a higher rate. Your doctor keeps track of these changes in your blood with a hematocrit reading. Your hematocrit is a measure of the percentage of the blood that is red blood cells. Your hemoglobin level is also tested. Hemoglobin is the protein component of red blood cells. If you are anemic, your hematocrit is lower than 37 and your hemoglobin is under 12. A hematocrit determination is usually made at the first prenatal visit, along with other lab work. It may be repeated once or twice during pregnancy. It is done more often if you are anemic. There is always some blood loss at delivery. If you're anemic when you go into labor, you are at higher risk of needing a blood transfusion after your baby is born. Follow your doctor's advice about diet and supplementation if you suffer from anemia. Iron-Deficiency Anemia The most common type of anemia seen in pregnancy is iron-deficiency anemia. During pregnancy, your baby uses some of the iron stores you have in your body. If you have iron-deficiency anemia, your body doesn't have enough iron left to make red blood cells because the baby has used some of your iron for its own blood cells. Iron is contained in most prenatal vitamins and can also be taken as a supplement. If you are unable to take a prenatal vitamin, you may be given 300 to 350mg of ferrous sulphate or ferrous gluconate 2 or 3 times a day. Iron is the most important supplement to take. It is required in almost all pregnancies.
The goal in treating iron-deficiency anemia is to increase the amount of iron you consume. Iron is poorly absorbed through the gastrointestinal tract and must be taken on a daily basis. It can be given as an injection, but it's painful and may stain the skin. Side effects of taking iron supplements include nausea and vomiting, with stomach upset. If this occurs, you may have to take a lower dose. Taking iron may also cause constipation. If you cannot take an oral iron supplement, an increase in dietary iron from foods, such as liver or spinach, may help prevent anemia. Sickle-Cell Anemia For women who are dark-skinned, sickle-cell anemia can cause significant anemia during pregnancy. Anemia occurs in these cases because the bone marrow, which produces the body's red blood cells, cannot replace red blood cells as quickly as they are destroyed. In sickle-cell anemia, the red blood cells produced are also abnormal, which can cause anemia or severe pain. You may carry the trait for sickle-cell anemia without having the disease. You could possibly pass the trait or the disease to your baby. Tell your doctor of any family history of the disease. A blood test easily detects the sickle-cell trait. Sickle-cell anemia can be diagnosed in the fetus with amniocentesis (discussed in Week 16) or chorionic villus sampling (discussed in Week 10). Women with sickle-cell trait are more likely to have pyelonephritis (see Week 23) and bacteria in the urine during pregnancy. They are also susceptible to developing sickle-cell anemia during pregnancy. Women with sickle-cell anemia may have repeated episodes of pain (sickle crises) throughout their lifetime. Pain in the abdomen or limbs is caused by the blockage of blood vessels by abnormal red blood cells. Episodes of pain may be severe and may require hospitalization for treatment with fluids and pain medication. Hydroxurea has proved effective as the treatment of the disease, but its use carries some risks. Because we do not have research data on long-term effects, pregnant women are advised not to use it. Sickle-cell disease risks to a pregnant women are those of painful sickle crisis, infections and even congestive heart failure. Risks to the fetus include a high incidence of miscarriage and stillbirth, estimated to be as high as 50%. Even though the risks are greater, many women with sickle-cell anemia have successful pregnancies. Thalassemia A type of anemia encountered less frequently is thalassemia, which occurs most often in Mediterranean populations. It is characterized by underproduction of part of the simple protein that makes up red blood cells, and anemia results. If you have a family history of thalassemia or know you have thalassemia, discuss it with your doctor. How Your Actions Affect Your Baby's Development Lower-Back Pain Lower-back pain is a common problem during pregnancy. Almost every pregnant woman experiences back pain at some point in her pregnancy, including mild to moderate pain that may increase as pregnancy progresses. However, as mentioned previously, pain may be an indication of more serious problems, such as pyelonephritis or a kidney stone. Check with your doctor if back pain is a chronic problem for you. It's OK to take acetaminophen (Tylenol) for back pain. Use heat on the area that is painful. If pain becomes constant or more severe, talk to your doctor about it. Driving a Car as Pregnancy Progresses I am often asked whether it's safe to drive a car during pregnancy. The answer is ôYes.ö I tell patients it may be more uncomfortable for them to get in and out of a car as their abdomens grow larger, but it shouldn't interfere with their ability to drive. As discussed in Week 12, it's important for you to use a seat belt and shoulder harness during pregnancy, as well as all other times. There is no reason not to drive while you're pregnant if your pregnancy is normal and you feel OK.
Fluid Intake Kathleen was concerned because she heard she should drink more fluid during pregnancy. She wanted to know how much she needed to consume. What she heard is true: Fluid intake during pregnancy is important. I told Kathleen that she might feel better if she drank more fluid than she normally did. Many women who suffer with headaches and various other problems during pregnancy find increasing their water intake helps resolve some of their symptoms. It's best to avoid fluids that contain a lot of calories, such as soda. Drink plain water or water with a little fruit juice added for flavor. You'll find it can be very refreshing and tasty. Some women find it helps to have a glass of water at hand all day. Decrease your intake in the early eveningùyou don't want to be up all night going to the bathroom! However, even if you decrease your fluid intake at night, you may find you're going to the bathroom a lot anyway. This is a normal part of pregnancy.
You Should also Know Do You Have Hemorrhoids? Hemorrhoids are a common problem during or following pregnancy. Hemorrhoids are dilated blood vessels around the area of the anus or inside it. They are caused during pregnancy by the increased blood flow in the area around the uterus and the pelvis because of the weight of the uterus, causing congestion or blockage of circulation. Hemorrhoids may worsen toward the end of pregnancy. They may also get worse with each succeeding pregnancy. Hemorrhoid treatment includes avoiding constipation by eating adequate amounts of fiber and drinking lots of fluid. Hemorrhoids may also be avoided through the use of stool softeners. Other measures include sitz baths or suppository medications. These can be bought without a prescription. Very rarely, hemorrhoids are treated during pregnancy with surgery. After pregnancy, hemorrhoids usually improve, but they may not go away completely. You can use the treatment methods mentioned above when pregnancy is over. If hemorrhoids cause you a great deal of pain, discuss it with your doctor. He or she will know what treatment method is best for you.
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