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Week 8 If you've just found out you're pregnant, you might want to start by reading the previous sections. How Big Is Your Baby? By your 8th week of pregnancy, the crown-to-rump length of your baby is 0.56 to 0.8 inch (14 to 20mm). This is about the size of a pinto bean. How Big Are You? Your uterus is getting bigger, but it probably still isn't big enough for you to be showing, especially if this is your first pregnancy. You will notice a gradual change in your waistline and the fit of your clothes. Your doctor will see that your uterus is enlarged if you have a pelvic exam. How Your Baby Is Growing and Developing Your baby is continuing to grow and to change rapidly during these early weeks. Compare the illustration on page 80 with the illustration for the 7th week of pregnancy. Can you see the incredible changes? Eyelid folds are forming on the face. The tip of the nose is present. Ears are forming, internally and externally. In the heart, the aortic and pulmonary valves are present and distinct. Tubes leading from the throat to the functioning part of the lungs are branched, like the branches of a tree. The body's trunk area is getting longer and straightening out. Elbows are present, and the arms and legs extend forward. Arms have grown longer. They bend at the elbows and curve slightly over the heart. The digital rays, which become fingers, are notched. Toe rays are present on the feet. Changes in You Changes in Your Uterus Before pregnancy, your uterus was about the size of your fist. After 6 weeks of growth, it is about the size of a grapefruit. As the uterus grows, you may feel cramping or even pain in your lower abdomen or your sides. Some women feel tightening or contractions of the uterus. The uterus tightens or contracts throughout pregnancy. If you don't feel this, don't worry. However, when contractions are accompanied by bleeding from the vagina, consult your physician. Sciatic-Nerve Pain Many women experience an occasional excruciating pain in their buttocks and down the back or side of their legs as pregnancy progresses. This is called sciatic-nerve pain. The sciatic nerve runs behind the uterus in the pelvis to the legs. We believe pain is caused by pressure on the nerve from the growing, expanding uterus. The best treatment for the pain is to lie on your opposite side. This helps relieve pressure on the nerve. How Your Actions Affect Your Baby's Development Use of Accutane Some women notice an improvement in their acne during pregnancy. But this doesn't happen for everyone. Accutane« (isotretinoin) is commonly prescribed for the treatment of acne. Do not take Accutane during pregnancy! Taken during the first trimester, Accutane is responsible for a higher frequency of miscarriage and malformation of the fetus. If you are pregnant or think you might be pregnant, don't take Accutane. Use reliable birth control to avoid pregnancy if you do use it. Miscarriage Miscarriage occurs when a pregnancy ends before the embryo or fetus can survive on its own outside the uterus. Nearly every pregnant woman thinks about miscarriage during pregnancy, but it occurs in only about 15% of all pregnancies. What Causes a Miscarriage? We don't usually know and are often unable to find out what causes a miscarriage. The most common finding in early miscarriages is an abnormality in the development of the early embryo. Studies indicate more than half of all early miscarriages have chromosomal abnormalities. Many factors can affect the embryo and its environment, including radiation, chemicals (drugs or medications) and infections. Called teratogens, these adverse factors are discussed in depth in Week 9. We believe various maternal factors are important in some miscarriages. Unusual infections, such as listeria, toxoplasma and syphilis, have been implicated in miscarriages. We have no concrete evidence that deficiency of any particular nutrient or even a moderate deficiency of all nutrients causes a miscarriage. Women who smoke have a higher rate of miscarriage. Alcohol is also blamed for an increase in miscarriages. Ruby, 8 weeks pregnant, was upset when she came for her first prenatal visit. Her last pregnancy had ended in miscarriage at 8 weeks, and she was scared she would have a miscarriage with this pregnancy. I assured her there were no indications it would happen this time. She left the office looking forward to her next visit, when she could probably hear the baby's heartbeat. The trauma of an accident or major surgery has been related to an increase in miscarriages, although this is difficult to verify. An incompetent cervix (see Week 24) is a cause of pregnancy loss after the first trimester. Many women have blamed emotional upset or trauma for a miscarriage, but this is hard to prove. Below is a discussion of different types of and causes of miscarriage. It is included to alert you about what to watch for if you have any symptoms of a miscarriage. If you have questions, discuss them with your doctor. Threatened Miscarriage A threatened miscarriage may be presumed when there is a bloody discharge from the vagina during the first half of pregnancy. Bleeding may last for days or even weeks. There may or may not be any cramping or pain. Pain may feel like a menstrual cramp or a mild backache. Resting in bed is about all you can do, although being active does not cause miscarriage. No procedures or medication can keep a woman from miscarrying. Threatened miscarriage is a common diagnosis because 20% of all women experience bleeding during early pregnancy but not all miscarry. Inevitable Miscarriage An inevitable miscarriage occurs with the rupture of membranes, dilatation of the cervix and passage of blood clots and even tissue. Miscarriage is almost certain under these circumstances. The uterus usually contracts, expelling the fetus or products of conception (so-called when no embryo or fetus is present). Incomplete Miscarriage With an incomplete miscarriage, the entire pregnancy may not be passed at once. Part of the pregnancy is passed while part of it remains in the uterus. Bleeding may be heavy and continues until the uterus is empty. Missed Miscarriage A missed miscarriage can occur with prolonged retention of an embryo that died earlier. There may be no symptoms or bleeding. The time period from when the pregnancy failed to the time the miscarriage is discovered is usually weeks. Habitual Miscarriage This term usually refers to three or more consecutive miscarriages. If You Have Problems If you have problems, notify your doctor immediately! Bleeding usually appears first, followed by cramping. Ectopic pregnancy must be considered a possibility. A quantitative HCG may be useful in identifying a normal pregnancy, but a single test report usually won't help. Your doctor needs to repeat the test over a period of days. Ultrasound may help if you are more than 5 gestational weeks into your pregnancy. You may continue to bleed, but seeing your baby's heart beat and a normal-appearing pregnancy may be reassuring. If the first ultrasound is not reassuring, you may be asked to wait a week or 10 days and then repeat the ultrasound. The longer you bleed and cramp, the more likely you are to be having a miscarriage. If you pass all of the pregnancy and bleeding stops and cramping goes away, you may be done with it. However, if everything is not expelled, it may be necessary to perform a D&C (dilatation and curettage) to empty the uterus. It is preferable to do this so you won't bleed for a long time, risking anemia and infection. Some women are given the hormone progesterone to help them keep a pregnancy. The use of progesterone to prevent miscarriage is controversial. Doctors do not agree on its use or its effectiveness. Rh-Sensitivity and Miscarriage If you're Rh-negative and you have a miscarriage, you will need to receive RhoGAM. This applies only if you are Rh-negative. RhoGAM is given to protect you from making antibodies to Rh-positive blood. (This is discussed in Week 16.) If You Have a Miscarriage One miscarriage can be traumatic; two in a row can be very difficult to deal with. Repeated miscarriages occur due to chance or ōbad luckö in most cases. Most doctors don't recommend testing to find a reason for miscarriage unless you have three or more. Chromosome analysis can be done, and other tests investigate the possibility of infections, diabetes and lupus. Don't blame yourself or your partner for a miscarriage. It is usually impossible to look back at everything you've done, eaten or been exposed to and find the cause of a miscarriage. You Should also Know Lab Tests Your Doctor May Order At your first or second visit, routine lab tests are performed. You will have a pelvic exam, including a Pap smear. Other tests include a CBC (complete blood count), urinalysis and urine culture, a test for syphilis (VDRL or ART) and cervical cultures, as indicated. Many doctors test blood sugar (to look for diabetes). They also test for your immunity against rubella and your blood type and Rh-factor. Other tests are done as needed. Tests are not performed at each visit; they are done at the beginning of pregnancy and as needed. Tests for hepatitis are now standard. Rubella during Pregnancy It's a good idea to be checked for immunity to rubella before you get pregnant. Rubella (German measles) during pregnancy can be responsible for miscarriage or fetal malformation. Because there is no known treatment for rubella, the best approach is prevention. If you're not immune, you can receive a vaccination while you take reliable birth control. Do not have a vaccination shortly before or during pregnancy because of the possibility of exposing the baby to the rubella virus. Toxoplasmosis If you have a cat, you may be concerned about toxoplasmosis. The disease is spread by eating raw, infected meat or by contact with infected cat feces. It can cross the placenta to your baby. Usually an infection in the mother has no symptoms. Infection during pregnancy can lead to miscarriage or an infected infant at birth. Antibiotics, such as pyrimethamine, sulfadiazine and erythromycin, can treat toxoplasmosis, but the best plan is prevention. Hygienic measures prevent transmission of the disease. Avoid exposure to cat feces (get someone else to change the kitty litter). Wash hands thoroughly after petting your cat, and keep your cat off counters and tables. Wash your hands after contact with meat and soil, and cook meat thoroughly.
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