WEEK-BY-WEEK GUIDE TO YOUR PREGNANCY
Is your pregnancy test positive? Congrats! If this is your first pregnancy, you most probably feel amazing and slightly anxious about what to expect from it. It is a good idea to know what you’re in for, because while being pregnant is the most beautiful and exciting journey in a woman`s life, it can also turn into a hormonal roller-coaster. Let our week-by-week guide to your pregnancy provide you with the necessary knowledge of what are the most essential pregnancy diagnostic services you are going to need to ensure you foetus’s well-being, as well as what is to be expected during the next nine months of your life. As they say, knowledge is power and knowing that your baby`s development is going as it should be and the annoying symptoms you experience are considered to be normal – will give you the strength and assurance.
2 weeks after your last period is when conceptions occur. By week 4, the fertilised egg has implanted in the lining of your womb. You will miss your upcoming period and you may notice a slight swelling or tenderness in your breasts.
- Your baby’s central nervous system start to develop. Your baby’s head is large compared to the rest of the body
- Your baby develops from an embryo (about 2mm long) at week 5 to a foetus (about 15mm long) at about week 8
- At week 6, the heart beat can be seen on ultrasound scan
At this stage, you may have confirmed your pregnancy with a urine pregnancy test. There is a spike in hormonal levels to prepare you and your body for pregnancy and you may start to experience from nausea or vomiting.
Folate supplement is recommended as it has been proven to reduce the incidence of brain and spinal cord abnormalities. As the central nervous system develops in early pregnancy, it is highly advisable to take folate supplements in the first 3 months of pregnancy.
- At the end of week 12, all the limbs and most of the organs of your baby would have been formed
- Your baby now has ears, a nose and eyelids which are closed
- Your baby moves freely although you cannot feel any of these movements yet
You may be frequenting the toilet more often due to the increased pressure on your bladder from the developing foetus. You are advised to have an ultrasound around week 12 of your pregnancy as the due date can be most accurately estimated at this time. Assessment of multiple pregnancies (if any) and first trimester screening (FTS) for Down syndrome can be carried out as well.
- Around week 20, your baby will have his own set of fingerprints
- Your baby starts to move, kick, swallow and even hear your voice
- Your baby will open his eyelids for the first time and start to sleep and wake in regular pattern
- At the end of week 24, your baby is 30cm in length and weighs about 500grams
By week 20, most mothers-to-be will feel fetal movements. Stretch marks may start to form on your tummy, breasts and thighs. Pregnant women should avoid lying flat on their backs for long periods of time from this point onwards. A small pillow should be wedged beneath one side of the back when sleeping.
It is highly advisable to have a fetal anomaly screening scan to assess the baby’s structure around week 18 to 21. This examines the structural anatomy of the foetus to check for major anomalies; paying special attention to the brain, face, spine, heart, lungs, stomach, bowel, kidneys, limbs, genitalia and umbilical cord.
- Your baby becomes more active
- As your baby swallows amniotic fluid, he/she may have hiccups which are often felt as slight movements that last for a few minutes
- Around 28 weeks, vernix will appear on your baby’s skin. This white, fatty substance protects his/her skin like a waterproof coat to prevent it from becoming soggy in the amniotic fluid
- By the end of week 28, the baby will measure about 40cm and weigh about 900grams
Other people can now feel your baby moving inside you. Minor discomforts such as leg cramps, heartburn, constipation and varicose veins may become worse. At week 28, women who are at risk of developing gestational diabetes (diabetes in pregnancy) are advised to have the oral glucose tolerance test.
- Baby is putting on fat and filling out
- During the next 12 weeks, the weight will double
- Wrinkly skin begins to smooth out
- By week 32, most babies would have moved upside down (cephalic presentation)
- By the end of week 32, the baby is about 45cm and weighs about 1500grams
You may experience breathlessness and heartburn as the womb continues to expand upwards. You may begin to feel very tired again. You may occasionally feel your tummy going tight and hard (Braxton Hick’s contractions). They are rehearsal contractions for labour and may last up to a couple of minutes but are usually painless. It would be important for you to begin monitoring fetal movements from now onwards. Normally, you should feel the baby move at least 10 times in 12 hours.
- There’s less room inside your womb for your baby to move around as he/she grows bigger
- Due to the maturity of his brain, the previously frantic and erratic movements will seem more deliberate and purposeful
- Your baby begins to move into the pelvis to prepare for delivery (engagement)
- By the end of week 36, your baby measures 50cm and weighs about 2400grams
Once your baby has gotten into position for delivery, you will usually feel more comfortable (lightening). However, after the baby’s head has engaged, there will be less room for your bladder so you will frequent the bathroom frequently and often during the night. Your sleep pattern may be disrupted as it tends to become uncomfortable at night.
- Your baby has matured and is now ready for delivery
- The growth may slow down towards week 40 when the placenta becomes “older”
- The average length of full-term babies is 51cm and the average weight is 3 to 3.5kg
Final preparations for the arrival of the baby should be done at this stage. Make sure your bags are packed and the nursery is ready. Consult your doctor or check into the hospital if any of the following symptoms are experienced:
- Painful and regular contractions that are between 45 to 60 seconds long, 5 minutes apart lasting more than one hour
- Sudden gush of clear fluid from the birth passage
- Heavy bleeding from the birth passage
- Decrease fetal movements (less than 10 movements in 12 hours)
PREGNANCY DIAGNOSTIC SERVICES
There is a wide range of screening procedures and tests you will need to be done during your pregnancy to ensure you baby is developing as it should be. Those pregnancy diagnostic services are performed all at the proper time, which is to be advised by your doctor.
- Obstetric Ultrasound Scans: Sound waves generate an image of your baby inside the uterus. This is an efficient, safe and painless way to examine the foetus. It is considered to be an indispensable obstetric tool and plays a crucial role in the care of every pregnant woman.
- Viability scan:Best done before 10 weeks of pregnancy. Aside from diagnosing and confirming early pregnancy, it can also confirm the location of pregnancy to be within the uterus.
- Dating scan: Performed between 8 to 13 weeks of pregnancy is most accurate in the prediction of the due date of the baby by measuring the length of the baby from the head to the buttocks (crown-rump length). The presence and type of multiple pregnancies can be accurately diagnosed with this scan.
- First trimester screening for Down syndrome: OSCAR (One Stop Clinic for the Assessment of Risk) is the First Trimester Screening that assesses the risk of the baby having Down syndrome. The most accurate way of estimating the risk of carrying a Down Syndrome baby is by combining the information from:
- Age of the mother
- Findings from an ultrasound scan at 11 to 13+6 weeks pregnancy (the nuchal translucency scan)
- Information obtained from the levels of two hormones (free ß-hCG and PAPP-A) in the mother’s blood.
- Fetal anomaly screening scan: A detailed scan is done at around 18 to 21 weeks. It examines the structural anatomy of the foetus to check for major anomalies. It pays special attention to the brain, face, spine, heart, lungs, stomach, bowel, kidneys, limbs, genitalia and umbilical cord. Minor variations of normal anatomy (soft markers) which are found more commonly in babies with chromosomal abnormalities are also examined. During the scan, the growth of the foetus, the amount of amniotic fluid, placental position and uterine blood flow are also assessed.
- Growth scan: Performed in the second half of the pregnancy to assess the growth and well-being of the baby. The baby’s head, abdomen and thigh bone are measured during the scan. The amount of amniotic fluid around the baby is assessed, the baby’s activity is observed and the position of the placenta is recorded.
- Doppler ultrasound scan for fetal surveillance: A special ultrasound application used to evaluate the blood flow between the placenta to the foetus such as the umbilical artery as well as blood flow within major fetal vessel (Middle Cerebral Artery and the Ductus Venosus). This scan is used to detect early signs of oxygen deprivation in foetuses that are not growing as well as expected. The results will help to assess the condition of the foetus and to time the delivery of an intrauterine-growth-restricted foetus. Some other important applications of the scan are the detection of fetal anemia and management of pregnancies complicated by twin-twin transfusion syndrome.
- Cervical length surveillance and cervical cerclage: Used to scan women who are at high risk for preterm delivery due to cervical incompetence, multiple pregnancies, previous preterm birth, abnormalities of the uterus or previous cervical surgery. The length of the cervix is measured. A shortened cervical length may increase the risk of a preterm delivery. In indicated cases, a stitch may be placed at the cervix to prevent premature dilation.
- 3D and 4D ultrasound scans: 3D ultrasound scan makes a three dimensional image of your baby while 4D Ultrasound Scan is four dimensional (time). The 4D scan takes 3 dimensional 3D ultrasound images and adds the element of time to the process. This will let you to see your baby in amazing real time detail. At around 12 weeks into the pregnancy, you will be able to see your whole baby. Between 25 to 32 weeks of pregnancy is the best time to see your baby’s facial features. All ultrasound scans are done with a monitor within the view of the mother and her partner, allowing the mother to watch as the ultrasound is completed. The mother will be given a keepsake of the baby. For 3D/4D scans, a short DVD of your baby will be given to the women to bring home.
- Amniocentesis: A sample of the fluid surrounding the foetus in the womb (the amniotic fluid) is analysed. This procedure is performed from 15 weeks of pregnancy onwards. An ultrasound will be used to guide the way and a fine needle is inserted through abdomen and into the fluid surrounding the foetus. 20ml of amniotic fluid is then removed and sent for analysis.
- Chronic villus sampling (CVS): A sample of the placenta is analysed. This procedure is performed from 11 weeks onwards. An ultrasound is used to guide the way and a needle is inserted through the abdomen into the developing placenta. Suction is applied and a small sample of tissue is extracted and sent to the laboratory. The procedure will take 5 to 10 minutes. It may be a little more uncomfortable than amniocentesis for the mother. However, the foetus is unaware of the procedure. A preliminary result may be available within 48 hours thanks to modern techniques. The final result will be ready in two weeks after the procedure.
- Screening for Gestational Diabetes Mellitus (GDM): A type of diabetes that some women develop during pregnancy. The risk factors include a family history of diabetes mellitus, a history of GDM in previous pregnancies, maternal age of 35 years and above and a high body-mass index (BMI). Women who are at risk of developing GDM should be screened with an Oral Glucose Tolerance Test (OGTT) at week 28 or earlier. They must fast for 8 hours to do OGTT. Their fasting blood sugar will be measured and will be given a drink containing 75gm of glucose. Their blood sugar level will be tested again after 2 hours. If the result is positive, women with GDM should be taught how to maintain a normal blood sugar level to decrease poor outcome for the pregnancy and the baby.
- Screening for Group B Streptococcus (GBS): GBS is a type of bacteria found in 15% of all healthy pregnant women’s vagina or rectum. Sometimes, a woman with GBS can pass the bacteria to the baby during delivery which may result in severe infections of her newborn. Provision of intravenous antibiotics during labour for women who have GBS can greatly reduce the risk of their newborns getting the infection. Between 35 to 37 weeks of pregnancy is the best time to screen for GBS. This test involves a swab of both the vagina and the rectum.
- Assessment of Pre-Eclampsia (PE): PE is a condition that affects some pregnant women and it is marked by high blood pressure accompanied with a high level of protein in the urine. The pregnant woman’s kidney and liver functions may also become affected. It may have a negative impact on both the pregnant woman and her foetus. This makes it very important to diagnose the condition early. The symptoms include high blood pressure and swelling in the feet, legs and hands. A single reading of high blood pressure is not sufficient to diagnose the condition as many mothers have transient raised blood pressure due to anxiety. On the other hand, swelling of hands and feet is a common occurrence in normal healthy pregnancy. Therefore, it is not enough to diagnose the condition. If the condition is confirmed, the appropriate treatment will be offered to the woman. The pregnant woman and her unborn baby will be monitored closely for the rest of her pregnancy.
- Cardiotocograph (CTG): A non-invasive external electronic device used during the third trimester to monitor and record the fetal heart rate and uterine contractions. CTG reading result will aid in the assessment of the fetal well-being.
There is a tendency for the levels of free ß-hCG to be increased and PAPP-A to be decreased in pregnancies affected by Down syndrome. An ultrasound scan known as the nuchal translucency scan is performed between 11 and 13+6 weeks of pregnancy when the fluid at the back of the baby’s neck (the nuchal translucency) is measured.While all babies have some fluid here, babies with Down syndrome will have increased fluid. The fetal anatomy will also be examined as there are some physical abnormalities that may be diagnosed at this stage. The fetal skull and brain, nasal bone, arms, legs, stomach, spine, abdomen and bladder will be examined. This scan should be done by trained personnel who have been accredited by the Fetal Medicine Foundation.