Third Trimester

A. Small blood vessels in the cervical area commonly break as a result of intercourse late in pregnancy, but there is nothing dangerous about it. In fact there is an (unproven) theory that the prostaglandin in semen helps to soften the cervix, making labor faster and easier. As you can imagine, this is not a simple matter for reliable investigation, but certainly does stand to reason.

A single reading of this sort is not going to provide definitive information. However, if another reading still shows no growth, this could be due to inadequate delivery of oxygen and/or nutrients to the baby. There is a form of late pregnancy testing which can shed more light on this.

A. Most likely, this pain is being caused by the normal separation of the area of the pubic bone we call the symphysis. There is actually a joint in this midline area which opens up a bit, and this provides more room for descent of the baby during labor. This separation, however, causes the two ends of the bone to rub together, which can be quite painful. Think of it as your body’s way of telling you that it’s time to rest more and walk less.

A. The major issue of importance here is the question of whether your membranes have ruptured prematurely. Your OB caregiver needs to be notified right away, as the only way to tell is by a speculum exam.

A. I don’t think you heard your doctor correctly. 1 cm. is entirely normal and indicates nothing. 3 cm. is not normal and could well indicate a prematurity risk. Be sure to clarify this with him/her as there are steps which can be taken to reduce prematurity risks to the baby.

A. Very likely it’s heartburn, as your large uterus forces acid into the esophagus. It will continue to happen, but should respond well to antacids. The baby does not experience the same thing.

A. Most likely these symptoms are a variety of ways in which you are responding to changes in your baby’s position within your uterus. When the baby is low, it causes congestion in the vaginal area and when it’s high, it will tend to cause pressure upwards toward the chest. None of these are at all dangerous and should resolve themselves fairly quickly, although you will likely experience them and other pressure symptoms more frequently over the next few weeks. The good news: At around 37-38 weeks, the baby should settle into a more or less final position so the changes won’t be as noticeable.

A. That’s pretty hard to respond to since there is only one sac of waters for each fetus (other than some very rare instances), so the implication here is that there may have been an unrecognized second twin fetus here at some earlier point. The reason this is strange is that this situation, which, by the way, is not terribly unusual, would usually be detected much earlier on ultrasound. In any event, this is not likely at all to produce any problems for you.

A. What this means is that it is quite likely that you will deliver prematurely, most likely in the next few days, so some special precautionary measures will need to be taken to improve your baby’s chances for survival. Nowadays, most babies do survive at this gestation, although several weeks of hospitalization will be required.

A. Ultrasound at this point of pregnancy has no accuracy whatever in determining gestational age, so it is most unlikely that anything is wrong at all. However, it is valuable to make sure that a baby is growing adequately and that there is a normal volume of amniotic fluid surrounding the baby.

A. I doubt if there is anything as comfortable for a term pregnant woman than to be immersed in a nice hot bath. This, among other things, brings an increased blood supply to your uterus, which is why your baby began to move more vigorously. Do continue to enjoy this as long as you can.

A. Yes, it is. Mucus is a normal product of the glands within the colon and is not a sign of any disorder. As with similar glands within the cervix, the amount produced can increase during pregnancy and become more noticeable.

A. You are at a point in your pregnancy where you should be doing what we call “daily kick counting”. This is an excellent mechanism for reassuring yourself of fetal well-being. Briefly, you should set aside some quiet time, preferably after dinner, when you can avoid preoccupation and can focus upon fetal movement. Your goal is to determine how many minutes it takes for your baby to move 10 separate times. In most cases, this will be accomplished in just a very short time, say 15 or 20 minutes. If, however, the 10th movement has not occurred by 60 minutes, then you need to start over. If this failure to move 10 times in 60 minutes happens again, you should proceed directly to the hospital for more intensive testing. Kick counting from 28 weeks onward has been shown to cut the stillbirth rate in half and should be done by all pregnant women. Your provider likely can give you a form on which to maintain these records.

A. I am so glad you asked this question, as there is so much misinformation out there about what women at term should be doing to help bring on labor. To begin with, there has long been the false belief that labor is brought on by walking around a lot. While women have tended to buy this because of all the pelvic discomfort that this activity produces, it is completely false. What women should actually do is spend as much time as possible at rest and taking in good amounts of liquids, as this is what will result in increased blood flow to the uterus which brings with it oxygen and nutrients needed to make the uterus contract. If you doubt this, pay attention to what happens when you first get off your feet; you will most likely feel an increase in the contractions we call Braxton-Hicks. That said, there is great benefit to ambulating once labor is established as gravity will help bring the baby down against the cervix and open it up rapidly. However, ambulating does not help to initiate labor and most likely actually tends to inhibit it. There is another approach, albeit a bit controversial and certainly not scientifically tested, which I mention only because I have seen it work many times in my practice. Sexual intercourse results, as we all know, in the deposition of semen onto the cervix. This material is absolutely loaded with a hormone called Prostaglandin, which is know to both soften the cervix and stimulate uterine contractions. Naturally, this particular approach will need to be employed only if comfort permits, which is not always the case. It must also be avoided if there are certain risk factors such as ruptured membranes or placental bleeding problems.

A. This sounds like a situation requiring a dramatic reduction in activity levels. Your body is simply not able to keep up with all the demands being placed upon it right now. You should do what you can to go off of work right away and spend the majority of the day off your feet between now and the delivery. Also, pay attention to your diet, so that you eliminate empty calories and focus upon healthy food and a good level of fluid intake.

A. Not really, unless it is accompanied by mucus and some level of contractions. Blood vessels in the cervix are easily broken, but do not have any predictive significance.

A. Small blood vessels in the cervical area commonly break as a result of intercourse late in pregnancy, but there is nothing dangerous about it. In fact there is an (unproven) theory that the prostaglandin in semen helps to soften the cervix, making labor faster and easier. As you can imagine, this is not a simple matter for reliable investigation, but certainly does stand to reason.

A. Not necessarily. Fetal position changes, lactation and Braxton-Hicks contractions are all common in the third trimester and do not usually result in pre-term labor.

A. You are experiencing what are called Braxton-Hicks contractions, which are entirely normal at this stage. They can be quite uncomfortable and also tend to divert blood flow away from the intestines so that digestion can be impaired. The good news is that this will all be over soon.

A. Your mother-in-law is correct. Your joints are starting to open so as to ease the labor process. This is not related to premature labor. If your contractions continue to become more frequent and stronger, your doctor can examine your cervix, which is the only way to detect premature labor

A. This is a fairly common and harmless condition called dysfunctional labor. It means that your uterine muscles are contracting in an uncoordinated fashion. At 36 weeks, there is no reason to try to inhibit contractions, as labor at this point does not pose a hazard to either you or your baby. The matter will resolve itself soon.

A. It is not possible to accurately date a pregnancy during the third trimester, so your EDD does not change as a result of this measurement. Also, fetal weight estimates by ultrasound tend not to be reliable. As far as testing the baby’s well-being is concerned, daily kick counting is as good a paramater as there is.

A. Most likely nothing is wrong with you other than you carrying around a lot of extra baggage – the baby and about 25 pounds of extra water. Women in the third trimester should look for every possible opportunity to be off their feet. That said, it would be advisable to evaluate a few things, such as your blood count and blood sugar to be sure you’re not becoming anemic or diabetic. If you are reassured about these things, just look at it as an opportunity to rest.

A. I doubt if there is anything as comfortable for a term pregnant woman than to be immersed in a nice hot bath. This, among other things, brings an increased blood supply to your uterus, which is why your baby began to move more vigorously. Do continue to enjoy this as long as you can.

A. Yes, you should. Your baby is now requiring substantial levels of nutrition, and yogurt will not provide it. This may be a simple matter of gastric reflux, which is not difficult to control. Start with trying some ordinary antacids, but do bring this to your doctor’s attention if this does not help.

A. At this point in pregnancy, nearly all women are developing acid reflux in which stomach acids back up into the esophagus due to pressure from below. You can generally keep this sort of symptom to a minimum by the use of antacids and this is perfectly safe for both mother and baby.

A. Hip replacement surgery does not necessarily require you to have a C-section, so long as you are able to flex your thighs adequately to open the pelvis. In fact, it should be avoided if possible as it will certainly slow down your ability to get around following the birth, which is not something favorable in someone who has had this type of surgery. Ordinarily, C-section recovery takes about eight weeks. I would not expect it to be longer because of your hip status.

A. These are not signs of labor, but, rather, your body preparing for labor. This consists mostly of your cervix softening and opening a tiny bit as well as the digestive system emptying and blood flow shifting to the region of the uterus. The more you see of this sort of thing before actual labor, the better off you are as some amount of the work of labor will be accomplished beforehand.

A. This is normal. In late pregnancy, the uterus will contract whenever there is some sort of postural change. This includes even the slight positional change which occurs when the bladder empties. It does fall within the definition of Braxton-Hicks contractions, so it has nothing to do with actual labor.

A. In the absence of itching, burning or a bad odor, it’s probably nothing more than a combination of cervical mucus and epithelial cells, which is very normal.

A. No, it doesn’t. The way you will know that your baby is coming is that your labor will start. No other methods can predict when delivery will occur.

A. There is no possible way for an exam of the cervix be used to predict when someone will deliver, so unless there is some additional information regarding your situation, you may disregard that prediction.

A. This is not likely to be of any great importance, but should still be communicated to your doctor if it has not resolved in the next two or three days. Bleeding in pregnancy is never considered normal, but, at a very low level as you describe, usually resolves itself.

A. This is a sign of hormonal change which is a common event in the third trimester. These changes cause fluctuations in blood flow to the skin, which causes these symptoms. It is not dangerous and does not need attention.

A. This is what is called the “bloody show.” It indicates that the cervix is starting to shorten, or efface. It usually means that labor will be starting in the next few days.

A. Neither of these findings have any bearing whatever on when labor will start. There is no benefit to knowing the status of your cervix unless this information is needed in order to plan some intervention, such as trying to head off a premature birth or inducing labor for some good reason.

A. Kidney infections at any stage of pregnancy are dangerous and usually do require hospitalization. It would not be advisable to undergo a C-section until the infection is cleared, unless there is no other alternative.

A. Yes, it could, but this would not be a dangerous thing at this point in the pregnancy. If the fall created bruising of the uterine muscle, this could result in enough irritability to trigger labor. Most likely, what will happen is that the injury would not be enough to cause labor and the cramping will gradually diminish over the next few days.

A. This is a very common position for the cord and does not subject the fetus to any increased hazards prior to delivery, although it can become a problem in labor if it interferes with adequate blood flow to the baby. Monitoring will nearly always detect if that is becoming a problem.

A. It doesn’t sound like your water broke as that is usually pretty dramatic, continuous, and hard to miss. On the other hand, you need to be sure that the repetitive vomiting hasn’t caused you to become dehydrated, which happens easily during pregnancy. Be sure to report if this level of vomiting happens again.

A. Most of the time, sharp back pains in late pregnancy are caused by pressure upon and stretching of nerves coming from the lumbar area as a result of the dramatic changes in posture that are occurring. Generally, reduced activity will cause this to resolve, but if that doesn’t happen, bring it to your doctor’s attention.

A. It’s not likely to be a plugged duct as that is caused by milk which solidifies in the duct, and significant milk flow does not usually start until after the birth occurs. More likely, there is the beginning of milk production without flow which is causing pain. Ice packs to the area for a few minutes at a time should keep this under control for now.

A. At this gestation, stomach acids have a tendency to back up into the esophagus, causing acid indigestion. Antacids will help a bit, but don’t expect this to clear completely until after the birth.

A. Premature birth (prior to 37 weeks) is quite likely here, especially as you are already under treatment to prevent labor. The good news is that with premature newborn care as effective as it is nowadays, healthy survival is the rule and not the exception at your current gestation.

A. Your cervix being slightly open does not mean that you are at any increased risk of delivering prematurely, unless, of course, you are having strong and regular contractions as well. In any event, 34-week births do not usually create any serious problems for the newborn.

A. I am so glad you asked this question, as there is so much misinformation out there about what women at term should be doing to help bring on labor. To begin with, there has long been the false belief that labor is brought on by walking around a lot. While women have tended to buy this because of all the pelvic discomfort that this activity produces, it is completely false. What women should actually do is spend as much time as possible at rest and taking in good amounts of liquids, as this is what will result in increased blood flow to the uterus which brings with it oxygen and nutrients needed to make the uterus contract. If you doubt this, pay attention to what happens when you first get off your feet; you will most likely feel an increase in the contractions we call Braxton-Hicks. That said, there is great benefit to ambulating once labor is established as gravity will help bring the baby down against the cervix and open it up rapidly. However, ambulating does not help to initiate labor and most likely actually tends to inhibit it. There is another approach, albeit a bit controversial and certainly not scientifically tested, which I mention only because I have seen it work many times in my practice. Sexual intercourse results, as we all know, in the deposition of semen onto the cervix. This material is absolutely loaded with a hormone called Prostaglandin, which is know to both soften the cervix and stimulate uterine contractions. Naturally, this particular approach will need to be employed only if comfort permits, which is not always the case. It must also be avoided if there are certain risk factors such as ruptured membranes or placental bleeding problems.

A. 1-2 cm. and 50 percent effaced really don’t mean anything as far as predicting the onset of labor. This being other than your first pregnancy, you actually stand a good chance of going to term, which is best for the babies, even if it’s uncomfortable for you. 36 weeks would be a good goal to shoot for.

A. What would be best is not worry about this situation. It is clear that you do not have diabetes, if that’s what your test showed. There is nothing surprising about big parents having big babies. Be aware that estimates of fetal weight are notoriously undependable. I have not seen many 6′ tall women who have had trouble delivering their babies.