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Week 27
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How Big Is Your Baby?

This week marks the beginning of the third trimester. In addition to weight and crown-to-rump length, I'm adding total length of your baby's body from head to toe. This will give you an even better idea of how big your baby is during this last part of your pregnancy.

Your baby now weighs a little more than 2 pounds (1000g), and crown-to-rump length is about 9.6 inches (24cm) by this week. Total length is 15.3 inches (34cm). See the illustration on page 225.

How Big Are You?

Your uterus is about 2.8 inches (7cm) above your bellybutton. If measured from the pubic symphysis, it is more than 10.5 inches (27cm) from the pubic symphysis to the top of the uterus.

How Your Baby Is Growing and Developing

Eye Development

Eyes first appear around day 22 of development in the embryo (about 5 weeks gestation). In the beginning, they look like a pair of shallow grooves on each side of the developing brain. These grooves continue to develop and eventually turn into pockets called optical vesicles. The lens of each eye develops from the ectoderm. (Ectoderm is discussed in Week 4.)

Early in development, eyes are on the side of the head. They move toward the middle of the face between 7 and 10 weeks of gestation.

At about 8 weeks gestation, blood vessels form that lead to the eye. During the 9th week of gestation, the pupil forms, which is the round opening in the eye.

By the 8th or 9th week of gestation, the nerve connection from the eyes to the brain begins to form. This nerve is called the optic nerve.

Eyelids that cover the eyes are fused (connected together) at around 11 to 12 weeks. They remain fused until about 27 to 28 weeks of pregnancy, when they open.

The retina, at the back of the eye, is light-sensitive. It is the part of the eye where light images come into focus. It develops its normal layers by about the 27th week of pregnancy. These layers receive light and light information, and transmit it to the brain for interpretationùwhat we know as sight.

Congenital Cataracts

A congenital cataract is an eye problem that may occur at birth. Most people believe cataracts only occur in old age, but that's a misconception. They can appear in a newborn baby! Instead of being transparent or clear, the lens that focuses light onto the back of the eye is opaque or cloudy. This problem is usually caused by a genetic predisposition. However, it has been found in children born to mothers who had German measles (rubella) around the 6th or 7th week of pregnancy.

Microphthalmia

Another congenital eye problem is microphthalmia, in which the overall size of the eye is too small. The eyeball may be only two-thirds its normal size. This abnormality often occurs with other abnormalities of the eyes. It frequently results from maternal infections while the baby is developing inside the uterus, such as cytomegalovirus (CMV) or toxoplasmosis.

Changes in You

Your breasts have probably gone through many changes as your pregnancy has progressed. Your breasts were probably very tender or sore early in pregnancy. Discomfort may have continued as they have increased in size.

Discovering a Breast Lump

Discovering a breast lump at any time is important, during pregnancy or any other time. It's important for you to learn at an early age how to do a breast exam on yourself and to perform this on a regular basis (usually after every menstrual period). Nine out of 10 breast lumps are found by women examining themselves.

Your doctor will probably perform exams at regular intervals, usually when you have your annual Pap smear. If you have an exam every year and are lump-free, it helps assure you no lumps are present before beginning pregnancy.

Finding a breast lump may be delayed during pregnancy because of changes in your breasts. It may be more difficult to feel a lump. Enlargement of the breasts during pregnancy and nursing tends to hide lumps or masses in the tissue of the breast.

Usually a breast exam is done at some point during pregnancy, perhaps at your first prenatal visit. If your breasts are very tender, this exam may be postponed until later in pregnancy.

Examine your breasts during pregnancy as you do when you are not pregnant. Do it every 4 or 5 weeksùthe first day of every month is a good time to do it.

Tests for Breast Lumps

The routine test for breast lumps is examination by yourself or your doctor. Other tests include X-ray examination, called a mammogram, and ultrasound examination of the breast.

If a lump is found, it may be necessary to have an ultrasound exam performed on the breast, or a mammogram. Because a mammogram utilizes X-rays, your pregnancy must be protected during the procedure, usually by shielding your abdomen with a lead apron.

It has not been shown that pregnancy accelerates the course or growth of a breast lump. But we do know it is difficult to find a breast lump because of breast changes.

Treatment during Pregnancy

Often a lump in the breast can be drained or aspirated. Fluid removed from the cyst is sent to the lab for evaluation to ensure there are no abnormal cells in the fluid. If a lump or cyst cannot be drained by a needle, a biopsy of the cyst or lump may be necessary.

If fluid is clear, it's a good sign. Bloody fluid is of more concern and must be studied under a microscope in the laboratory.

If examination of a lump indicates breast cancer, treatment during pregnancy is not significantly different from treatment for nonpregnant women. Treatment complications include the need for medication, such as anesthesia for a biopsy. If a lump is cancerous, the need for radiation therapy and chemotherapy must be considered.

How Your Actions Affect Your Baby's Development

Falling and Injuries from Falls

A fall is the most frequent cause of minor injury during pregnancy. Fortunately, a fall is usually without serious injury to the baby or to the mother. The uterus is well protected in the abdomen inside the bony pelvis. The baby is protected against injury by the cushion of amniotic fluid surrounding it. Your uterus and abdominal wall also offer some protection.

If You Fall

If you fall, contact your doctor; he or she may want to examine you. You may feel reassured if you are monitored and your baby's heartbeat is checked. The baby's movement after a fall can be reassuring.

Minor injuries to the abdomen are treated in the usual fashion, as though you were not pregnant. However, avoid X-rays if possible.

Ultrasound evaluation may be important after a fall. This is judged on an individual basis, depending on the severity of your symptoms and your injury.

Take Care to Avoid Falls

Remember your balance and mobility change as you grow larger during pregnancy. Be careful during the winter when parking lots and sidewalks may be wet or icy. Many pregnant women also fall on stairs. Always use the handrail.

Slow down a little as you get larger; you won't be able to get around as quickly as you normally do. With the change in your balance, plus any dizziness you may experience, it's important to be vigilant about this.

You Should also Know

Prenatal Classes

Wendy asked me when she should think about signing up for prenatal classes. Even though she was just beginning the third trimester, I told her it wasn't too early to think about and to register for these classes. It's a good idea to get signed up for classes so you can take them before you get to the end of your pregnancy. By doing this, you'll have time to practice what you learn. You won't be just beginning your classes when you deliver!

During pregnancy, you have probably been learning what's going to happen at delivery by talking with your doctor and by asking questions. You have also learned what lies ahead from reading materials given to you by your doctor, from other books, such as Your Pregnancy Questions & Answers and Your Pregnancy After 30, or from pamphlets. Childbirth classes offer yet another way to learn about this important part of pregnancy. They help you prepare for labor and delivery.

Classes are usually held for small groups of pregnant women and their partners or labor coaches. This is an excellent way to learn. You can also interact with other couples and ask questions. You'll discover other women are concerned about many of the same things you are, such as labor and pain management. It's good to know you aren't the only one thinking about what lies ahead.

Childbirth classes are offered in various settings. Most hospitals that deliver babies offer prenatal classes, often taught by the labor-and-delivery nurses or by a midwife. Other types of classes have different degrees of involvement. This means the time commitment or depth of the subject covered is different for each of the various classes that may be available.

Ask your doctor or your doctor's nurse about classes they recommend. They can help you decide which type of class would be best for you.

Classes are intended to inform you and your partner or labor coach about what to expect, what happens at the hospital and what happens during labor and delivery. Some couples find classes are a good opportunity to get their partner more involved and to help make him feel more comfortable with the pregnancy. This may give him the opportunity to take a more active part at the time of labor and delivery, as well as during the rest of your pregnancy.

By meeting in class on a regular basis, usually once a week for 4 to 6 weeks, you can learn about many things that concern you. Classes often cover a wide range of subjects, including the following areas.

ò Will you need an episiotomy?

ò Do you need an enema?

ò When is a fetal monitor necessary?

ò What's going to happen when you reach the hospital?

ò Is an epidural or some other type of anesthesia right for you?

These are important questions. Discuss them with your doctor if they are not answered in your childbirth-education classes.

Prenatal classes are not only for first-time pregnant women. If you have a new partner, if it has been a few years since you've had a baby, if you have questions or if you would like a review of what lies ahead, a prenatal class can help you.

These classes may reduce the worry and concern you and your partner may feel about labor and delivery. And they'll help you enjoy the birth of your baby even more.

Home Uterine Monitoring

Home uterine monitoring is used to identify women with premature labor. Conditions associated with premature delivery include a previous preterm delivery, infections, premature rupture of membranes, pregnancy-induced hypertension and multiple fetuses.

Home uterine monitoring combines recording uterine contractions with daily telephone contact with the healthcare provider. A recording of contractions is transmitted from the woman's home by telephone to a center where contractions can be evaluated. Thanks to personal computers, your doctor may be able to view the recordings at his or her own home.

Cost for home monitoring varies but runs between $80 and $100 a day; some insurance companies cover it. The cost of home monitoring can often be justified if a premature delivery is preventedùit saves thousands of dollars in the care of a premature baby (sometimes more than $100,000).

Not everyone agrees that home monitoring is beneficial or cost-effective. It may be difficult to identify all the patients who need this type of monitoring. Need for home uterine monitoring should be considered on an individual basis. Discuss this option with your physician if you have experienced preterm labor in the past or have other risk factors for preterm labor.

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From Your Pregnancy Week by Week by Glade B. Curtis, M.D., OB/GYN. Copyright by Fisher Books. Electronic rights by Medical Data Exchange.

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