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Welcome to your Third Trimester (part 9) - Doppler scans

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- How to have natural miscarriage
- Foods That Cause Miscarriage
- Signs Proving You Have Boy Pregnancy
You are 27 Weeks and 3 Days 88 days to go…

Pregnancy is a subject about which everybody has an opinion they want to share with you, whether you like it or not.

Your baby today

This baby is at the end of a yawn. Your baby is yawning in a more coordinated way now with one yawn often following another. It may look as if this image shows the fingertips in the bottom right but in fact it is a foot, nearly brought up to the mouth.

Although you may have become very proud and protective of your belly, it can be extremely irritating if other people become overprotective of you. You may find that everyone has an opinion on your pregnancy, and what you should and should not be doing to stay healthy. Some women find all the attention comforting, but others find it frustrating or suffocating. If you’re someone who finds all the advice difficult to handle, try to remember that people mean well.

Of course, it’s your body, and you’ll do what is best for you and your baby. If it’s all getting too much, then try talking to the main offenders, often a partner, mother, or mother-in-law. Explain that you’re trying your best and that you’re aware of what you should and shouldn’t do while you’re pregnant and are following the advice of your doctors. Politely thank them for their input and reassure them that you’re taking good care of yourself and your baby.

… Your health
Blood pressure checks

About 8 percent of women have problems with high blood pressure in pregnancy. High blood pressure can be caused by preeclampsia, a serious condition that also leads to protein in the urine. Preeclampsia can affect the liver and kidneys and, if untreated, lead to eclampsia or seizures. If you have preeclampsia, your doctor will closely monitor your blood pressure. High blood pressure can affect also your baby, so medication may be recommended. Don’t stop the medication without your doctor’s okay.

On smelling good

Are you wafting through pregnancy feeling fresh as a daisy? It’s rarely discussed, but being pregnant may make you feel less fragrant than usual, not least because you will sweat more than before—although it’s unlikely that anyone else will have noticed. An increase in vaginal discharge is also nothing to worry about, but if it smells offensive or is yellowish or greenish in color, you could have an infection so see your doctor. To stay smelling sweet:

  • Shower or bath regularly and apply deodorant every time. Take handy wipes with you to stay fresh all day.

  • Use body sprays and lotions if your usual fragrance doesn’t smell “right”: they tend to be lighter and are less likely to cause headaches.

  • Avoid wearing tight clothing: wear loose clothes in natural fabrics, which absorb sweat and allow your skin to breathe.

  • Wear cotton underwear, and change it more often, if necessary.

  • Use disposable panty liners, if needed, to stay feeling fresh.

Choose the perfume you put on carefully since you may find that some scents, even one you’re used to wearing, make you feel nauseous or light-headed during pregnancy.

Assessing Fetal Growth and Well-being

In addition to monitoring your own health and well-being throughout your pregnancy, the doctor will also assess how your baby is growing and will refer you for further tests if she has any concerns about your baby’s well-being.

Measuring your baby

In a low-risk pregnancy, the abdomen is measured at prenatal visits to assess the baby’s growth. The measurement in centimeters from the top of your pubic bone to the top of your uterus (the fundus) should be about the same as the number of weeks you are pregnant, with an allowance of up to 2 cm either way. For example, if you are 26 weeks’ pregnant, you should measure between 24 and 28 cm. Your fundal height can be measured between 24 and 36–37 weeks, since once your baby “drops” into the pelvis in late pregnancy, the measurement may not reflect his or her true size. If there is a variation of 3 cm or more, your doctor will arrange for an ultrasound to check your baby’s growth (see Growth charts) and the amount of amniotic fluid. If the scan indicates a problem, the doctor will arrange for scans every two weeks since analyzing growth patterns over time gives a more accurate assessment of whether your baby’s growth is normal.

In certain cases, for example if a woman is obese, in twin pregnancies, and where there are large uterine fibroids, the only accurate way to measure growth is by ultrasound.

Measuring your abdomen helps the doctor monitor your baby’s growth.

Measuring growth with ultrasound in late pregnancy

By late pregnancy, the length of your baby can no longer fit on the screen and so his or her size will be calculated by combining several measurements in a mathematical formula, as is done at the 20-week scan . Measurements include the width of the head (biparietal diameter), circumference of the head, and the abdominal circumference, which are plotted on a graph over a period of time (see Growth charts). The length of the upper leg bone (femur length) may also be measured. If your baby is smaller than the 10th percentile or has a small abdomen, you may have more tests to assess his or her well-being (see Your baby’s well-being). A measurement above the 90th percentile can be a sign of gestational diabetes and will need investigating. Also, if your baby is at the larger end of the scale, your doctor may recommend you have a cesarean delivery.

Your baby’s well-being

If there are concerns over your baby’s growth, you may be referred for a “non-stress” test and/or biophysical profile testing, which observe how your baby responds to stimuli and if there are signs of fetal distress. If you have a known condition that can affect your baby’s growth (see Growth charts), your doctor may arrange for you to have one or both of the above tests once or twice a week after about 32 weeks’ gestation as a matter of routine, whether or not there are concerns about your baby’s growth. Some hospitals also perform special scans, known as Doppler scans to assess placental blood flow.

A non-stress test

This test assesses your baby’s well-being. An external transducer is placed on your abdomen to listen for accelerations in your baby’s heart rate that last about 15 seconds. The mother may or may not notice any fetal movement during these accelerations. The test result is thought to be “reassuring” if the heart accelerates twice over 20–30 minutes, and there are no large decelerations. About 10–20 percent of babies have a test with less than two accelerations. This doesn’t necessarily mean there is a problem: your baby may just have been asleep, and the test may be repeated.

A biophysical profile (BPP)

If, after the non-stress test, your doctor has concerns about your baby, a biophysical profile (BPP) may be done. A BPP combines the results of a CTG reading with a scan to evaluate four factors: the volume of amniotic fluid, fetal movement, fetal muscle tone and posture, and fetal breathing. Two points are given for each part of the test, so a “reassuring” BPP result would be eight points.

Growth charts

If your doctor has any concerns about your baby’s growth later in pregnancy, he or she may arrange for scans to be done over a period of time so that your baby’s growth can be plotted on a chart and monitored. Individual measurements will be taken of the head, abdomen, and limbs. Measurements of the head and abdomen are most important since an unequal growth pattern in these areas may indicate a particular problem.

The three lines on the graphs here represent different growth rates. The red line in the center, referred to as the 50th percentile, shows an average pattern of growth. The thinner lines above and below, the 90th and the 10th percentiles, show the top and bottom ranges of normal growth. Since the head and abdominal circumferences are measured over time and plotted on a graph, a pattern of growth becomes clear. Here, the head is growing normally, but growth has slowed in the abdomen, possibly due to a placental problem that in itself may be caused by a condition in the mother. For example, conditions such as high blood pressure  or diabetes  can affect placental blood flow. If the blood flow to the baby is restricted, this can result in the oxygen and nutrients carried in the blood being diverted to the baby’s most vital organs, the brain and heart, rather than to the abdominal organs, which results in unequal growth patterns in the head and abdomen.

Head circumference

Abdominal circumference

Doppler scans

A Doppler scan is a special scan that analyzes blood flow through the placenta. If the placenta is functioning well, the blood flows easily. If there is a problem in the placenta, it is resistant to the blood flow and the baby’s heart has to work harder to pump blood. In extreme cases, there are periods between your baby’s heartbeats of no blood flow or reversed blood flow through the umbilical cord. In this case, an early delivery may be suggested unless you’re very premature.

A normal Doppler reading shows the continuous blood flow to the baby via the placenta. At the beginning of a heart cycle, the pressure is high; it then dips at the end of the cycle, but doesn’t ever stop.

An abnormal reading indicates that there is resistance to blood flow in the placenta, resulting in very little or no flow at the end of the cycle. The baby may not receive sufficient oxygen, which can affect growth.

Q: I’ve heard about “kick counts.” Should I be doing these?
A: Fetal movement counting, or “kick counts,” is one way to monitor the well-being of your baby from 28 weeks onward. However it can cause undue worry to moms and other indicators of movement are important. These include noting a change in the pattern of movement and inactivity when your baby is normally active. Your doctor may ask you to write down your baby’s normal movement and call her immediately if there are any changes in the pattern.
Q: Can my baby move too much?
A: Usually, the more movement the better, even if this keeps you up at night or causes discomfort. An active fetus is not a sign that you’ll have a restless baby or hyperactive child.
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