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Week 29 How Big Is Your Baby? By this time, your baby weighs about 2.7 pounds (1250g). Crown-to-rump length is 10.4 inches (26cm). Total fetal length is 16.7 inches (37cm). How Big Are You? Measuring from your bellybutton, your uterus is about 3.5 to 4 inches (7.6 to 10.2cm) above it. Your uterus is about 11.5 inches (29cm) above the pubic symphysis. If you saw your doctor 4 weeks ago, around the 25th week of pregnancy, you probably measured about 10 inches (25cm) at that time. You've grown about 1.5 inches (4cm) in 4 weeks. Your weight gain by this week should be between 19 and 25 pounds (8.55 and 11.25kg). How Your Baby Is Growing and Developing Fetal Growth Week by week, I've noted the change in the baby's size as pregnancy progresses. I use average weights to give you an idea of about how large your baby is at a particular time. However, these are only averages; babies do vary greatly in size and weight. Because growth is rapid during pregnancy, infants born prematurely may be very small. Even a few weeks' less time in the uterus can have a dramatic effect on the size of your baby. The baby continues to grow after 36 weeks of gestation but at a slower rate. A couple of interesting factors have been identified with regards to the birth weight of your baby. ò Boys weigh more than girls. ò Birth weight of an infant increases with the increasing number of pregnancies you have or the number of babies you deliver. These are general statements and don't apply to everyone, but they appear to apply in most cases. The average baby's birth weight at full term is 7 to 7.5 pounds (3280g to 3400g). How Mature Is Your Baby? A baby born between the 38th and 42nd weeks of pregnancy is a term baby or full-term infant. Before the 38th week, the term preterm can be applied to the baby. At 42 weeks of pregnancy, and after this time, postterm is used. Postdate is a newer term that some doctors use. When a baby is born before the end of pregnancy, many people use the terms premature and preterm interchangeably. There is a difference. An infant that is 32 weeks gestational age but has mature pulmonary or lung function at the time of birth is more appropriately called a preterm infant than a premature infant. Premature best describes an infant that has immature lungs at the time of birth. Premature Babies Premature birth increases the risk of problems in the baby. It also increases the risk of fetal death. Babies born prematurely usually weigh less than 5.5 pounds (2500g). The illustration on page 243 shows a premature baby with several leads attached to monitor the baby's heart rate. Many other attachments are used, such as I.V.s, tubes and masks that provide oxygen. In 1950, the neonatal death rate was about 20 per 1000 live births. Today, the rate is less than 10 per 1000 live births. More preterm infants survive today than did 40 years ago. The decreasing death rate applies primarily to infants delivered during the third trimester (27 weeks or more of gestation) who weigh at least 2.2 pounds (1000g) and are without birth defects. When gestational age and birth weight are below these levels, the death rate increases. Better methods of caring for premature babies have contributed to higher survival statistics. Today, infants born as early as 25 weeks of pregnancy can survive. However, the long-term survival and quality of life for these babies remains to be seen as they grow older. What is the survival rate for premature babies? The most recent information indicates for infants who weighed 1.1 pound (500g) to 1.5 pounds (700g), the survival rate is about 43%. For babies weighing between 1.5 pounds and 2.2 pounds (1000g), the survival rate is about 72%. These rates vary from hospital to hospital. The average hospital stay for premature babies ranges from 125 days for infants weighing between 1.3 and 1.5 pounds (600 and 700g) to 76 days for babies in the 2- to 2.2-pound (900 to 1000g) birth-weight range. Any discussion of survival rates must include the frequency rate of disabilities these premature babies suffer. In the lower birth-weight range, many babies who survived had disabilities. Higher-weight babies also had disabilities, but statistics for this group were much lower. It's usually best for the baby to remain in the uterus as long as possible, so it can grow and develop fully. Occasionally it is best for the baby to be delivered early; for example, when the fetus is not receiving adequate nutrition. This is a rare occurrence.
Finding the cause of premature labor and delivery may be difficult. An attempt is always made to determine what causes preterm labor before active labor begins. In this way, treatment may be more effective. Some difficult questions that must be answered when premature labor begins include those below. ò Is it better for the infant to be inside the uterus or to be delivered? ò Are the dates of the pregnancy correct? ò Is this really labor? az Intrauterine-Growth Retardation Intrauterine-growth retardation (IUGR) refers to a fetus that does not grow as fast as it should while in the uterus. A baby suffering from IUGR has a higher risk of serious problems. (IUGR is discussed in depth in Week 31.) The word ôretardationö may cause a mother-to-be some concern. Retardation in this sense doesn't apply to the development or function of the baby's brain. It means the total growth and overall size of the baby are inappropriately small; growth and size are considered to be retarded. Changes in You Treatment of Premature Labor Can anything be done about premature labor? Yesùwe now can treat premature labor in several different ways. The treatment most often used for premature labor is bed rest. A woman is advised to stay in bed and lie on her side. (Either side is OK.) Not everyone agrees on this treatment, but bed rest is often very successful in stopping contractions and premature labor. If this happens to you, it may mean you can't go to work or continue many activities. It's worth it to agree to bed rest if you can avoid premature delivery of your baby. Beta-adrenergic agents, also called tocolytic agents, may be used to suppress labor. Beta-adrenergics are muscle relaxants. They relax the uterus and decrease contractions. (The uterus is mainly muscle, which is active in pushing the baby out through the cervix during labor.) At this time, only ritodrine (Yutopar«) is approved by the Food and Drug Administration (FDA) to treat premature labor. Ritodrine is given in three different forms. It can be given intravenously, as an intramuscular injection and as a pill. It is usually initially given intravenously and may require a hospital stay of a couple of days or more. When premature contractions stop, you can be switched to oral medications, which are taken every 2 to 4 hours. Ritodrine is approved for use in pregnancies over 20 weeks and under 36 weeks gestation. In some cases, medication is used without an I.V. first. This is done most often in women with a history of premature labor or for a woman with multiple pregnancies. Side effects related to the use of ritodrine may be very uncomfortable. Side effects include tachycardia (rapid heartbeat), hypotension, the feeling of apprehension or fear, chest tightness or chest pain, changes in the electrocardiogram (record of the heart's electrical activity) and pulmonary edema (fluid in the lungs). Ritodrine can cause maternal metabolic problems, including increased blood sugar, low blood potassium and even acidosis of the blood, similar to a diabetic reaction. Less serious complications include headaches, vomiting, shaking, fever and even hallucinations. Similar problems probably occur in the baby. Low blood-sugar levels have been seen in babies after birth in some mothers who took ritodrine before delivery. Rapid heartbeat is also commonly seen in these babies. Terbutaline is also frequently used as a muscle relaxant. Although it has been shown to be an effective medication, it has not been approved for this use by the FDA. Terbutaline side effects are similar to those of ritodrine. Magnesium sulfate is used to treat pre-eclampsia (see Week 31 for information on pre-eclampsia). We have known for quite a while that magnesium sulfate can also be used to help stop labor. This medication is most often given through an I.V. and requires hospitalization. However, it is occasionally given as an oral preparation, without hospitalization. Your doctor must monitor you frequently if magnesium sulfate is prescribed. Sedatives or narcotics may be used in early attempts to stop labor. This may consist of an injection of morphine or meperidine (Demerol). This is not a long-term solution but may be effective in initially stopping labor. Benefits of Stopping Premature Labor Benefits of stopping premature labor include reducing the risks of fetal problems and problems related to premature delivery. If you experience premature labor, see your doctor frequently. Your doctor will probably monitor your pregnancy with ultrasound or nonstress tests. How Your Actions Affect Your Baby's Development Most of our discussion this week has been devoted to the premature infant and treatment of premature labor. If you are diagnosed as having premature labor and your doctor prescribes bed rest and medications to stop it, follow his or her advice! If you're concerned about your doctor's instructions, discuss them with him or her. If you're told not to work or you are advised to reduce your activities and you ignore the advice, you're taking chances with your well-being and your unborn baby's. It isn't worth taking risks. Don't be afraid to ask for another opinion or the opinion of a perinatologist if you experience premature labor. You Should also Know Chlamydia Infections You may have heard about or read about chlamydia. It is a common sexually transmitted disease (STD); between 3- and 5-million people are infected every year. It may be difficult to determine if you have a chlamydial infection because you may not have symptoms. Between 20% and 40% of all sexually active women have probably been exposed to chlamydia at some time. Chlamydia infection can cause serious problems if left untreated, but these problems can be avoided with treatment. Infection is caused by a germ that invades certain types of healthy cells. Infection may be passed through sexual activity, including oral sex. Chlamydia is most likely to occur in young people who have more than one sexual partner. It may also occur in women who have other sexually transmitted diseases. Some doctors believe chlamydia occurs more commonly in women who take oral contraceptives. Barrier methods of contraception, such as diaphragms and condoms used with spermicides, may offer protection from chlamydial infections. One of the most significant complications of chlamydia is pelvic inflammatory disease (PID), a severe infection of the upper genital organs involving the uterus, the Fallopian tubes and even the ovaries. There may be pelvic pain, or there may be no symptoms at all. PID can result from an untreated infection that spreads throughout the pelvic area. Chlamydia is one of the main causes of PID. If a PID infection is prolonged or recurrent, the reproductive organs, Fallopian tubes and uterus may be damaged, with formation of adhesions. Surgery may be required to repair them. If tubes are damaged, scar tissue can increase the risk of ectopic or tubal pregnancy. Chlamydia in Pregnancy During pregnancy, a mother-to-be can pass a chlamydial infection to her baby as it comes through the birth canal and vagina. The baby has a 20% to 50% chance of getting chlamydia if the mother has it. It may cause an eye infection, but that is easily treated. Complications that are more serious include pneumonia, which may require the baby's hospitalization. Testing for Chlamydia Chlamydia can be detected by a cell culture, but as I've said, more than half of those infected with chlamydia have no symptoms. Symptoms that may appear include burning or itching in the genital area, discharge from the vagina, painful or frequent urination, or pain in the pelvic area. Men may also experience symptoms. Rapid diagnostic tests can be done in the doctor's office. They can provide a result quickly, possibly even before you go home. Chlamydia is usually treated with tetracycline, but this drug should not be given to a pregnant woman. During pregnancy, erythromycin may be the drug of choice. After treatment, your doctor may want to do another culture to make sure the infection is gone. If you're concerned about a possible chlamydial infection, discuss it with your doctor.
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