Move Baby Move

Week 23

Estimated reading time: 5 min reads

You will now be enjoying the fact you are over half way through your pregnancy at 23 weeks!  In little girls the ovaries, now containing a lifetime’s worth of eggs, is in place along with the uterus; the vagina matures. The reproductive system is also unfolding and maturing in little boys as the testes commence their descent.

Your baby’s skin has taken on a crumpled look; body fat is modest. Your baby’s skin tones appear to be transparent, anywhere from a light pink to a deep garnet hue. Your growing baby will experience the onset of rapid eye movements. The sense of taste will soon be realized as minute taste buds will soon be present on your baby’s tongue. The beginnings of little footprints and fingerprints begin this week which will be inked, stamped and printed for a lifetime of safety and identity on delivery day.

Your baby is now beginning to concentrate on taking his or her first breath. Little lungs and the blood vessels housed within them are growing quickly this week anticipating delivery day. The placenta continues to deliver adequate oxygen to your baby during this time.

Weighing barely over a pound and the size of a large grapefruit, babies delivered this week, in the right high-tech medical setting, may survive and actually look like babies!

Amniotic Fluid, Polyhydramnios and Oligohydramnios

Amniotic Fluid

(AF) is the watery fluid surrounding your baby inside the amniotic membrane (sac) and is an essential part of pregnancy and fetal development. This fluid helps shield and guard your baby while performing a significant part in the maturity of many of your baby’s organs such as the lungs, kidneys, and gastrointestinal track. AF is mainly produced by the excretion of your baby’s urine and the secretion of oral, nasal, tracheal, and pulmonary fluids that move across the placenta and into the mother’s circulatory system.

AF rates can vary, usually 500-1000 ml of fluid is present during a normal pregnancy. Did you know that amniotic fluid volume (AFV) increases from about 25 ml at 10 weeks to about 400 ml at 20 weeks and continues to replicate until you have reached 32-33 weeks? Around 28 weeks gestation, the AFV reaches a volume in the region of 800 ml and that level should remain constant until 40 weeks. After 40 weeks, the level usually declines and is around 400 ml by 42 weeks. An Amniotic Fluid Index (AFI) of 5-25 centimeters is considered normal and is also a part of the BPP. Too much or too little amniotic fluid may be related to abnormalities in growth and other pregnancy problems.
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(Also known as hydramnios) Occurs when there is too much amniotic fluid around the baby. This condition is present in approximately one percent of all pregnancies. Although there are both maternal and fetal causes of polyhydramnios such as a multiple pregnancy, maternal diabetes, twin-to-twin transfusion syndrome or a birth defect, the cause of polyhydramnios is unknown in approximately 65% of those diagnosed. This condition and its possible causes are usually diagnosed with an ultrasound and if detected, your health care provider will recommend a specific treatment plan.

When too much amniotic fluid is present, the mother’s uterus becomes over distended. With close monitoring that includes repeated ultrasounds calculating growth, BPPs, and fetal assessments, many cases of polyhydramnios are easily treated. If polyhydramnios is more serious, your team may use different treatments. Treatments may include administering medications up to Week 32 reducing the fluid production, performing an amnioreduction via amniocentesis that removes excess fluid, or scheduling an early delivery. Close monitoring and the treatment of polyhydramnios may avoid complications such as intrauterine growth restriction (IUGR), preterm labor, the premature rupture of membranes, which may increase the risk of placental abruption, umbilical cord prolapse with possible compression, and stillbirth.
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It is where there is too little amniotic fluid surrounding your baby. It affects about four percent of women and is usually diagnosed during the third trimester. The causes of oligohydramnios may include birth defects, placental problems, leaking or the rupture of membranes, post date pregnancy or maternal complications such as hypertension, diabetes, dehydration, or preeclampsia. If diagnosed during the first half of your pregnancy, more serious complications may result such as birth defects or a greater likelihood of miscarriage or stillbirth. One complication of prolonged deprivation of amniotic fluid is pulmonary hypoplasia, which results in an abnormal or incomplete development of the baby’s lungs. During the second half of your pregnancy, the complications of oligohydramnios may include IUGR, preterm birth and labor complications such as an increased risk for compression of the umbilical cord and aspiration of thick meconium (your baby’s first bowel movement).

Your baby’s gestational age is important when oligohydramnios is diagnosed because complications such as maternal hypertension, diabetes, or fetal genitourinary tract problems may occur. If diagnosed with oligohydramnios, both you and your baby will be closely monitored. Rigorous fetal biophysical surveillance including NST’s and frequent ultrasound evaluations will examine your baby’s level of mobility.

The treatment for oligohydramnios may be as simple as advising mom to hydrate with fluids orally or intravenously (IV), which may help to ensure that amniotic fluid levels will rise. For more severe cases of oligohydramnios during the antenatal period, an amnio-infusion is now an option. This procedure adds fluid via an intrauterine catheter into the amniotic cavity (however low amniotic fluids levels usually return within 7 days). Ultrasound visualization, made possible by this addition of fluid, may enable your health care team to determine the cause of oligohydramnios, thereby increasing the potential for a favorable outcome at delivery.

If you are near to full term and oligohydramnios endangers your baby’s well-being, then an early delivery may be necessary. An amnio-infusion may be performed during labor to help cushion the umbilical cord and reduce the chances of a cesarean section.

Oligohydramnios may cause complications in approximately 12% of pregnancies which go beyond 41 weeks. Pregnancies beyond 42 weeks may suffer from the amniotic fluid level dropping by 50%. For more information on polyhydramnios and oligohydramnios, please visit Medline Plus and the University of Rochester Medical Center.

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