Move Baby Move

Week 19

Estimated reading time: 10 min reads

Your baby may now be sucking a tiny thumb, shifting a little head or creating other diminutive movements that you may begin to sense. Your voice, speaking, humming and crooning, is the most pronounced sound your baby is now hearing.

Now your baby is acquiring a white, slippery, cheese-like covering called vernix caseosa. This layer will form over baby’s fine hair (lanugo) which now jackets the skin. Although the amniotic fluid which fills your baby’s uterine environment will protect your baby from bangs and bumps, the vernix caseosa aids in protecting the baby’s fragile skin from scrapes and chaffing that may occur from your baby’s immersion in this fluid.

Little kidneys continue working as urine is expelled into the amniotic environment holding your baby. The placenta, a major part of your baby’s life support system, is also busy working to eliminate these waste products from your baby’s surroundings. The vagina and uterus may begin developing in baby girls.

Your baby is about 6 inches long and the size of a shiny green zucchini.

Preeclampsia

One pregnancy complication affecting thousands of women and babies that has risen by twenty-five percent over the last twenty years is “Preeclampsia.” This serious medical problem affects 5%-8% of all pregnancies and 15% of these women develop HELLP (Hemolysis Elevated Liver enzymes and Low Platelets) Syndrome. Preeclampsia is a major source of maternal and infant illness and death. It usually occurs during the last half of pregnancy and rarely before Week 20; it may also strike in the postpartum period.

If this is your first pregnancy, the symptoms of nausea, vomiting and lower backache may be present. How do you distinguish these symptoms from the onset of preeclampsia? Early in your pregnancy speak with your health care team about preeclampsia as the symptoms of preeclampsia usually begin after Week 20. Your health care team may recommend the PreeclampsiaScreenSM l T1. This simple first-trimester blood test could help determine if you are at low or high risk for preeclampsia.

You may be at risk for developing preeclampsia if any of the following apply to your Personal History:

  1. First pregnancy.
  2. Obesity (BMI>30).
  3. African-American or Caribbean descent.
  4. Over 35 or under 20 years of age.
  5. High blood pressure before becoming pregnant.
  6. High blood pressure or preeclampsia in previous pregnancies.
  7. Diabetes before or during pregnancy.
  8. Kidney disease.
  9. A mother or sister who had preeclampsia.
  10. Multiple gestations (e.g., twins, triplets).
  11. Rheumatoid arthritis, lupus or other autoimmune disorders
  12. Some blood clotting disorders.
  13. Polycystic ovarian syndrome.
  14. In vitro fertilization.
  15. Sickle cell disease.

Or your Family History:

  1. Preeclampsia.
  2. High blood pressure or heart disease.
  3. Diabetes

Early Onset Preeclampsia is defined as preeclampsia resulting in the delivery of your baby before Week 34; babies delivered earlier than expected may face lifelong disabilities. Early onset preeclampsia may result in sudden health complications for mothers and escalate their risk for long-term cardiovascular disease. Women who have had preeclampsia have roughly double the risk for heart disease and stroke over the next five to 15 years of their lives. Early onset preeclampsia contributes more to the morbidity and mortality of pregnant moms and their babies than preeclampsia acquired late in pregnancy.

Preeclampsia is typically hallmarked by an increase in blood pressure and signs of damage to another organ system, most often the liver or kidneys. A significant level of protein in the urine (proteinuria) is no longer a criterion for diagnosing preeclampsia, and may ultimately delay diagnosis and treatment. Preeclampsia may be diagnosed without proteinuria when there are signs of damage to other organs.

Symptoms of preeclampsia may include, but are not limited to:

  1. High blood pressure.
  2. Weight gain of more than 5 pounds in one week.
  3. Edema with swelling in the face, hands and feet.
  4. Nausea and vomiting.
  5. Headache.
  6. Blurred or altered visual disturbances.
  7. Chest pain or shortness of breath.
  8. Low back pain.
  9. Pain in the upper right abdomen area.
  10. Shoulder pain.

Remember that even a slight rise in your blood pressure may be a sign of preeclampsia. Women whose blood pressure had been normal or women who already have naturally high blood pressure may begin to see a change, usually after Week 20. Make sure you are evaluated at every visit to ensure that you are not exhibiting any signs or symptoms of preeclampsia. Call your health care team if you experience any symptoms of preeclampsia for the first time. If you are unable to reach them, go to the ER or the L&D to be evaluated by a health care provider.

“The earlier you know, the earlier you and your doctor can take steps to prevent or delay the onset of preeclampsia.”

HELLP syndrome is a life-threatening pregnancy condition and considered a severe variant of preeclampsia. Approximately 45,000 women will develop HELLP syndrome in the United States every year. The physical symptoms of HELLP syndrome may appear to be preeclampsia; it may sometimes be mistaken for the flu or gall bladder problems. It may include one or all of the following:

  1. Abdominal or chest pain and right upper quadrant pain (from liver swelling).
  2. Nausea/vomiting/indigestion with pain after eating.
  3. Headaches that won’t go away, even after taking medication such as Tylenol.
  4. Shoulder pain or pain when breathing deeply.
  5. Bleeding.
  6. Changes in Vision: blurred, seeing double or flashing lights.
  7. Swelling of the face or hands.
  8. Shortness of breath: breathing with difficulty, gasping.

The only cure for preeclampsia begins with the delivery of your baby. Your health care team will take many factors into account to manage your preeclampsia such as when to deliver, gestational age, the health of you and your baby and a careful evaluation of how the disease is progressing. Ultrasounds may be essential to monitor your baby’s growth and medications may be indicated for you. Hospitalization may also be required as your symptoms may unexpectedly worsen necessitating the need for the careful and precise monitoring of both you and your baby.

preeclampsialogo Preeclampsia Foundations states: “When we urge women to trust themselves, we are referring to the intuitive feeling that preeclamptic women often have that “something is not right.” While these feelings may be nothing, it is important for women to report any concerns and for care providers to be diligent, particularly if accompanied by other signs or symptoms.”

If left untreated, preeclampsia can be dangerous and even fatal for both you and your baby. To ensure your and your baby’s wellbeing and to reduce bad outcomes from preeclampsia, it’s important to:

  1. Know the warning signs listed above.
  2. Trust yourself.
  3. Attend regular prenatal visits.
  4. Have a strong partnership with your health care team.
  5. If warning signs develop, call you health care team ASAP!

For further information regarding the signs, symptoms, care, treatment and how both preeclampsia and HELLP syndrome may affect you and your baby, please visit the Preeclampsia Foundation and the Mayo Clinic.

The Preeclampsia Registry is the first and only global collection of detailed patient-reported information for use by researchers! If you would like to be a part of the solution to help accelerate the discovery of the causes and options for prevention, diagnosis and treatment of preeclampsia, please visit The Preeclampsia Registry.

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Stillbirth

In the United States Stillbirth refers to the loss of a baby of twenty or more weeks gestation. Stillbirth is not a cause of death but rather a term indicating a baby has died in utero. The universal definition of when a loss is a stillbirth varies internationally making it difficult to gather and compare data and ultimately determine how frequently stillbirth occurs.

A stillbirth is the death of a baby before or during delivery. Approximately, one out of 160 pregnancies tragically end in stillbirth. Although the cause of many stillbirths is unknown, many are attributed to any of the following: birth defects and genetic problems, complications with the placenta or the umbilical cord, or possibly maternal diabetes, high blood pressure or obesity.

According to the CDC, a stillbirth is additionally categorized as either early, late, or term:

  • An early stillbirth is a fetal death occurring between 20 and 27 completed pregnancy weeks.
  • A late stillbirth occurs between 28 and 36 completed pregnancy weeks.
  • A term stillbirth occurs between 37 or more completed pregnancy weeks.

No race, income level, age group or ethnicity is immune to stillbirth. However, there are risk factors that may increase the likelihood of stillbirth. There is a higher incidence of stillbirth if you are of the black race, 35 years or older, overweight, a smoker, have endured an earlier loss, or have a medical condition such as diabetes or high blood pressure. These issues may put an expectant mother at risk for stillbirth or preterm birth.

A gradual decrease in fetal movement was noticed by fifty percent of mothers a few days prior to the death of their babies. A recent study in Norway noted a thirty percent reduction in stillbirth when pregnant women were encouraged to track fetal movement by their healthcare provider, and were told to immediately seek medical attention when they noticed any decline in their baby’s movements.

If you have had a previous stillbirth, your next pregnancy will be considered a High Risk pregnancy by your health care team and you will be referred to a Maternal Fetal Specialist for exceptional care. This necessary attention will be given to all aspects of your pregnancy. It may include more frequent medical visits, additional ultrasounds or specialized testing, and increased monitoring to be sure you and your baby are both doing well. If your health care team does not consider your subsequent pregnancy to be a high risk pregnancy, you should discuss your concerns with them including the option of transferring your care to another health care team.

Beginning at Week 20 every mom is encouraged to begin keeping a journal tracking her baby’s movements. Getting to know your baby’s movements and taking note of when your baby is stirring or slumbering is fundamental. Daily journaling will enable you to become familiar with the movements of your little one so your baby’s daily routine will become second nature to you. Knowing your baby’s patterns of movement will enable you to move easily into Movement Counting, which will begin around Week 28.

11267991_1673057172927314_5896841536561126187_n-300x300PAK encourages all pregnant moms to use our Mom & Baby Tracking Chart from Week 13 onwards. If for any reason you detect an unusual level of activity for your baby (an increase or decrease in fetal movement), you notice any sudden changes in movement, or once movement counting has commenced you are unable to obtain the usual 10 movements in your normal amount of time, call and visit your health care team to make sure that your baby is well. If you are unable to contact or visit your health care team, go to Labor and Delivery (L&D) as most L&D units will see you immediately for Decreased Fetal Movements (DFM), or go to the nearest Emergency Room (ER).

Discuss any changes to your Mom & Baby Tracking Chart with your health care team and don’t ever hesitate to call them about any questions or concerns that you may have, or comments that they may have made to you that you don’t understand. Your team is there to educate and inform you, that’s their job! You know your baby best, so always trust your gut.

For more information on stillbirth please visit the CDC. For more information on kick counting, please visit babyMed, and PAK’s Third Trimester Week 28 and Operation Due Date Mom & Baby Tracking Charts on our website.

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