Ultrasound: The baby can be measured as early as five or six weeks after the mother's last menstrual period. Measuring the baby using ultrasound is most accurate in early pregnancy. It becomes less accurate later in pregnancy. The best time to estimate gestational age using ultrasound is between the 8th and 18th weeks of pregnancy. The most accurate way to determine gestational age is using the first day of the woman's last menstrual period and confirming this gestational age with the measurement from an ultrasound exam.

Calculating Conception Date In a typical pregnancy: For a woman with a regular period, conception typically occurs about 1121 days after the first day of the last period. Most women do not know the exact date of conception, and their conception date is merely an estimate based on the first day of their last period.

77.Pregnancy and Birth Sourcebook, Third Edition Special cases: Women who undergo special procedures such as artificial insemination or in vitro fertilization typically know the exact date of conception.

Calculating Due Date Estimated due date: Based on the last menstrual period, the estimated due date is 40 weeks from the first day of the period. This is just an estimate since only about 5% of babies are born on their estimated due date.

Difficulties in Determining Gestational Age Last menstrual period: For women who have irregular menstrual periods or women who cannot remember the first day of their last menstrual period, it can be difficult to determine gestational age using this method. In these cases, an ultrasound exam is often required to determine gestational age.

Baby's growth: In some cases it is difficult to determine the gestational age because the baby is unusually large or small. Also, in some cases the size of the uterus in early pregnancy or the height of the uterus in later pregnancy does not match the first day of the last menstrual period. In these cases as well, it is difficult to obtain an accurate gestational age.

78.

Chapter 9.

Physical Changes during Pregnancy Chapter Contents.Section 9.1-Common Pregnancy Discomforts ........................... 80 Section 9.2-Back Pain during Pregnancy .................................. 89 79.Pregnancy and Birth Sourcebook, Third Edition Section 9.1 Common Pregnancy Discomforts The text in this section is from "Pregnancy Basics," by the Office of Women's Health (www.womenshealth.gov), part of the U.S. Department of Health and Human Services, March 2007. Figure 9.1 is from The Healthy Woman: The Healthy Woman: A Complete Guide for All Ages, A Complete Guide for All Ages, U.S. Department of Health and Human Services, Office on Women's Health, 2008. U.S. Department of Health and Human Services, Office on Women's Health, 2008.

Everyone expects pregnancy to bring an expanding waistline. But many women are surprised by the other body changes that pop up.

Get the lowdown on stretch marks, weight gain, heartburn, and other "joys" of pregnancy. Find out what you can do to feel better.

Body Changes Aches, Pains, and Backaches As your uterus expands, pains in the back, abdomen, groin area, and thighs often appear. Many women also have backaches and aching near the pelvic bone due the pressure of the baby's head, increased weight, and loosening joints.

To ease some of these aches and pains try: * lying down; * resting; and * applying heat.

If you are worried or the pains do not get better, call your doctor.

Breast Changes A woman's b.r.e.a.s.t.s increase in size and fullness during pregnancy.

As the due date approaches, hormone changes will cause your b.r.e.a.s.t.s to get even bigger in preparation for breastfeeding. Your b.r.e.a.s.t.s may feel full and heavy, and they might be tender or uncomfortable.

In the third trimester, some pregnant women begin to leak colostrum from their b.r.e.a.s.t.s. Colostrum is the first milk that your b.r.e.a.s.t.s 80 [image]

Physical Changes during Pregnancy produce for the baby. It is a thick, yellowish fluid containing antibodies that protect newborns from infection. If leaking becomes embarra.s.sing, put nursing pads inside your bra.

Try to these tips to stay comfortable: * Wear a soft, comfortable maternity or nursing bra with extra support.

* Wash your nipples with water instead of soap. Soap can dry and irritate nipples. If you have cracked nipples, use a heavy moisturizing cream that contains lanolin.

Dizziness Many pregnant women complain of dizziness and lightheadedness throughout their pregnancies. Fainting is rare but does happen even in some healthy pregnant women. There are many reasons for these Figure 9.1. Figure 9.1. Body changes during pregnancy. Body changes during pregnancy.

81.Pregnancy and Birth Sourcebook, Third Edition symptoms. The growth of more blood vessels in early pregnancy, the pressure of the expanding uterus on blood vessels, and the body's increased need for food all can make a pregnant woman feel lightheaded and dizzy.

To feel better follow these tips: * Stand up slowly.

* When you're feeling lightheaded, lay down on your left side.

* Avoid sitting or standing in one position for a long time.

* Eat healthy snacks or small meals frequently.

* Don't get overheated.

* Call your doctor as soon as possible if you faint. Dizziness or lightheadedness can be discussed at regular prenatal visits.

Hemorrhoids Up to 50% of pregnant women get hemorrhoids. Hemorrhoids are swollen and bulging veins in the r.e.c.t.u.m. They can cause itching, pain, and bleeding.

Hemorrhoids are more common during pregnancy for many rea- sons. During pregnancy there is a huge increase in the amount of blood in the body. This can cause veins to enlarge. The expanding uterus also puts pressure on the veins in the r.e.c.t.u.m. Plus, constipation can make hemorrhoids worse. Hemorrhoids usually improve after delivery.

Follow these tips to help prevent and relieve hemorrhoids: * Drink lots of fluids.

* Eat plenty of fiber-rich foods like whole grains, raw or cooked leafy green vegetables, and fruits.

* Try not to strain for bowel movements.

* Talk with your doctor before taking any laxative.

* Talk to your doctor about using witch hazel or ice packs to soothe hemorrhoids.

Leg Cramps At different times during your pregnancy, you might have cramps in your legs or feet. They usually happen at night. This is due to a change in the way your body processes, or metabolizes, calcium.

82.Physical Changes during Pregnancy Try these tips to prevent and ease leg cramps: * Eat lots of low-fat calcium-rich foods.

* Get regular mild exercise, like walking.

* Ask your doctor if you should be taking a prenatal vitamin containing calcium.

* Gently stretch the muscle to relieve leg and foot cramps. If you have a sudden leg cramp, flex your foot toward your body.

* Use heating pads or warm, moist towels to help relax the muscles and ease leg and foot cramps.

Nasal Problems Nosebleeds and nasal stuffiness are common during pregnancy.

They are caused by the increased amount of blood in your body and hormones acting on the tissues of your nose.

To ease nosebleeds blow gently when you blow your nose. Stop nosebleeds by squeezing your nose between your thumb and finger for a few minutes. If you have nosebleeds that do not stop in a few minutes or happen often, see your doctor.

Drinking extra water and using a cool mist humidifier in your bedroom may help relieve nasal stuffiness. Talk with your doctor before taking any over-the-counter or prescription medicines for colds or nasal stuffiness.

Shortness of Breath As the baby grows, your expanding uterus will put pressure on all of your organs, including your lungs. You may notice that you are short of breath or might not be able to catch your breath.

Tips to ease breathing include: * Take deep, long breaths.

* Maintain good posture so your lungs have room to expand.

* Use an extra pillow and try sleeping on your side to breathe easier at night.

Swelling Most women develop mild swelling in the face, hands, or ankles at some point in their pregnancies. As the due date approaches, swelling 83 Pregnancy and Birth Sourcebook, Third Edition often becomes more noticeable. If you have rapid, significant weight gain or your hands or feet suddenly get very puffy, call your doctor as soon as possible. It could be a sign of high blood pressure called preeclampsia or toxemia.

To keep swelling to a minimum: * Drink 8 to 10 eight-ounce gla.s.ses of fluids (water is best) daily.

* Avoid caffeine.

* Try to avoid very salty foods.

* Rest when you can with your feet elevated.

* Ask your doctor about using support hose.

Teeth and Gum Problems A pregnant woman's teeth and gums need special care. Pregnant women with gum disease are much more likely to have premature babies with low birthweight. This may result from the transfer of bacteria in the mother's mouth to the baby during pregnancy. The microbes can reach the baby through the placenta (a temporary organ joining the mother and fetus which supplies the fetus with blood and nutrients), through the amniotic fluid (fluid around the fetus), and through the layer of tissues in the mother's stomach.

Every expectant mother should have a complete oral exam prior to or very early in pregnancy. All needed dental work should be managed early, because having urgent treatment during pregnancy can present risks. Interventions can be started to control risks for gum inflammation and disease. This also is the best time to change habits that may affect the health of teeth and gums, and the health of the baby.

Remember to tell your dentist that you are pregnant! You can ease bleeding gums by brushing with a soft-bristled toothbrush and floss-ing at least twice a day. Get more details on taking care of your teeth and gums during pregnancy.

Varicose Veins During pregnancy there is a huge increase in the amount of blood in the body. This can cause veins to enlarge. Plus, pressure on the large veins behind the uterus causes the blood to slow in its return to the heart. For these reasons, varicose veins in the legs and a.n.u.s (hemorrhoids) are more common in pregnancy.

84.Physical Changes during Pregnancy Varicose veins look like swollen veins raised above the surface of the skin. They can be twisted or bulging and are dark purple or blue in color. They are found most often on the backs of the calves or on the inside of the leg.

Try these tips to reduce the chances of varicose veins: * Avoid tight knee-highs or garters.

* Sit with your legs and feet raised when possible.

Digestive Difficulties Constipation Many pregnant women complain of constipation. High levels of hormones in your pregnant body slow down digestion and relax muscles in the bowels leaving many women constipated. Plus, the pressure of the expanding uterus on the bowels boosts the chances for constipation.

Try these tips to stay more regular: * Eat fiber-rich foods like fresh or dried fruit, raw vegetables, and whole-grain cereals and breads daily.

* Drink eight to 10 gla.s.ses of water everyday.

* Avoid caffeinated drinks (coffee, tea, colas, and some other so-das), since caffeine makes your body lose fluid needed for regular bowel movements.

* Get moving. Mild exercise like walking may also ease constipation.

Heartburn and Indigestion Almost every pregnant woman experiences indigestion and heartburn. Hormones and the pressure of the growing uterus cause this discomfort. Pregnancy hormones slow down the muscles of the digestive tract. So food tends to move more slowly and digestion is sluggish. This causes many pregnant women to feel bloated.

Hormones also relax the valve that separates the esophagus from the stomach. This allows food and acids to come back up from the stomach to the esophagus. The food and acid causes the burning feeling of heartburn. As your baby gets bigger, the uterus pushes on the stomach making heartburn more common in later pregnancy.

85.Pregnancy and Birth Sourcebook, Third Edition Try these tips to prevent and ease indigestion and heartburn: * Avoid greasy and fried foods.

* Eat six to eight small meals instead of three large meals.

* Don't gain more than the recommended amount of weight.

* Take small sips of milk or eat small pieces of chipped ice to soothe burning.

* Eat slowly.

* Ask your doctor if you can take an antacid medicine.

Stretch Marks and Other Skin Changes Stretch Marks Worried about the dreaded stretch marks of pregnancy? Just about all pregnant women are. The good news is that only about half of pregnant women get stretch marks.

Stretch marks are red, pink, or purple streaks in the skin. Most often they appear on the thighs, b.u.t.tocks, abdomen, and b.r.e.a.s.t.s. These scars are caused by the stretching of the skin, and usually appear in the second half of pregnancy.

The color of stretch marks depends on a woman's skin color. They can be pink, reddish brown, or dark brown streaks. While creams and lotions can keep your skin well moisturized, they do not prevent stretch marks from forming. Most stretch marks fade after delivery to very light lines.

Other Skin Changes Some women notice other skin changes during pregnancy. For many women, the nipples become darker and browner during pregnancy.

Many pregnant women also develop a dark line (called the linea nigra) on the skin that runs from the belly b.u.t.ton down to the pubic hairline.

Blotchy brown pigmentations on the forehead, nose, and cheeks are also common. These spots are called melasma or chloasma and are more common in darker-skinned women. Most of these skin changes are caused by pregnancy hormones and will fade or disappear after delivery.

Tingling and Itching Tingling and numbness of the fingers and a feeling of swelling in the hands are common during pregnancy. These symptoms are due 86 Physical Changes during Pregnancy to swelling of tissues in the narrow pa.s.sages in your wrists, and they should disappear after delivery.

About 20 percent of pregnant women feel itchy during pregnancy.

Usually women feel itchy in the abdomen. But red, itchy palms and soles of the feet are also common complaints. Pregnancy hormones and stretching skin are probably to blame for most of your discomfort.

Usually the itchy feeling goes away after delivery. In the meantime, try these tips to feel better: * Use thick moisturizing creams instead of lotions on your skin.

* Use gentle soaps.

* Avoid hot showers or baths that can dry your skin.

* Avoid itchy fabrics and clothes.

* Try not to get overheated. Heat can make the itching worse.

Rarely, itchiness can be a sign of a serious condition called cholestasis of pregnancy. If you have nausea, loss of appet.i.te, vomiting, jaundice, or fatigue with itchiness, call your doctor. Cholestasis of pregnancy is a serious liver problem.

Sleeping Troubles During your pregnancy, you might feel tired even after you've had a lot of sleep. Many women find they're particularly exhausted in the first trimester. Don't worry, this is normal! This is your body's way of telling you that you need more rest.

In the second trimester, tiredness is usually replaced with a feeling of well being and energy. But in the third trimester, exhaustion often sets in again. As you get larger, sleeping may become more difficult. The baby's movements, bathroom runs, and an increase in the body's metabolism might interrupt or disturb your sleep. Leg cramping can also interfere with a good night's sleep.

Try these tips to feel and sleep better: * When you're tired, get some rest.

* Try to get about 8 hours of sleep every night, and a short nap during the day.

* If you feel stressed, try to find ways to relax.

* Sleep on your left side. This will relieve pressure on blood vessels that supply oxygen and nutrients to the fetus.

87.Pregnancy and Birth Sourcebook, Third Edition * If you have high blood pressure during pregnancy, always lay on your left side when you're lying down.