Pregnancy Tracker

Fetal Growth

• Sperm fertilizes the egg in one of the fallopian tubes and then 5-7 days later the fertilized egg implants (attaches) in the lining of the uterus or womb. The fertilized egg begins to grow in the uterus, doubling in size every day & becomes an embryo.
• The placenta & umbilical cord begin to form at the time of implantation. The placenta provides nourishment, oxygen, and hormones to your baby and carries away the baby’s waste.
• Your baby is enclosed in a sac of fluid to protect the baby from bumps and pressure.
• In another week the baby has a spinal cord, and a few days later five to eight bones of the spinal column (vertebrae) are in place.
• By the end of your first month of pregnancy, your baby has a head and trunk.
• The eyes and other features are beginning to form, as are tiny buds that will become the arms and legs.
• The heart also forms, and it begins to beat on the 25^th day.
• By the end of the month your baby is about ½ inch long and weighs a fraction of an ounce.

Your Health

• During this time it is important you take a multivitamin supplement that contains folic acid 0.4 milligrams daily.
  • Folic acid is a B vitamin that is essential for decreasing the risk of neural tube defects, such as spina bifida, anencephaly, and meningocele.
  • If you have previously had a child with a neural tube defect or are taking certain medications, you need to take a higher dose of 4 milligrams of folic acid daily.
• Urine pregnancy test becomes positive during this time due to the pregnancy hormone, Beta hcg.  The Beta hcg hormone increases anywhere from 66% to doubling every 48 hours in a normal pregnancy. This hormone supports the pregnancy & also causes morning sickness.  If you have bleeding in the early part of pregnancy, we may have to check your blood level of Beta hcg hormone level a few times to determine if the hormone is rising appropriately. This will help us determine if pregnancy is normal or abnormal.
• Please call the office for a new OB appointment in the next couple of days or weeks once your urine pregnancy test is positive.

Fetal Growth

• This month is especially critical in the development of your baby. Any disturbances from drugs, viruses, or environmental factors may cause birth defects.
• Your baby’s development is very rapid during the second month.
• By the end of the second month, all of your baby’s major body organs and body systems, including the brain, lungs, liver, and the stomach, have begun developing.
• The first bone cells appear. Ankles, toes, wrists, and fingers develop, as well as sexual organs.
• Eyelids form and grow but are sealed shut, and ears form.
• If your baby is a boy, his penis begins to appear.
• At the end of the month your baby looks like a miniature human infant. The baby is a little over 1 inch long and still weights less than 1 ounce. From now until birth the baby is called a fetus.

Your Health

• Your pregnancy hormone, Beta hcg, continues to increases anywhere from 66% to doubling every 48 hours. Due to this, your morning sickness may continue or even worsen. Try ginger ale, ginger tea, and pretzels to help with morning sickness. Eat small snacks throughout the day if cannot have a full meal. Remember to drink as much water as you can.
• Women with a normal body mass index (BMI) should gain between 25 pounds to 35 pounds during pregnancy. This means you need to add 300 extra calories per day to your baseline calorie intake during pregnancy. Gaining too much weight during the pregnancy increases risk of gestational diabetes, high blood pressure, macrosomia with possible birth injury & childhood obesity.
• Avoid eating shark, swordfish, king mackerel, or tilefish during pregnancy due to high mercury in these large fish. A pregnant woman can safely eat two meals of low mercury fish (shrimp, canned light tuna excluding albacore, salmon, Pollock, catfish) per week.
• Avoid unpasteurized milk or cheeses, raw or undercooked meat/poultry/shellfish, hot dogs or deli meats (unless they are heated till steaming hot) during pregnancy to avoid listeriosis (an infection that can lead to fetal death)

Office Visit

• You should be having your initial visit with a WHS provider.
• At this visit you will receive a prenatal vitamin prescription and information about office fees and policies.
• This is an important visit in that much of your medical history will be obtained including information about previous pregnancies. It is essential you inform you provider regarding any complications with past pregnancies such as elevated blood pressures, gestational diabetes, preterm labor, shoulder dystocia, hemorrhage, infection. Please also inform your provider if you have had a previous c-section or any other surgeries on your uterus. We do not do vaginal delivery after c-section (VBAC).
• Your provider may refer you to a maternal fetal medicine specialist for a consultation if you have a condition that requires a further evaluation, such as advanced maternal age, diabetes, chronic hypertension, heart disease, thyroid disease, pulmonary disease, history of preterm labor, etc. A maternal fetal medicine specialist is an OB/GYN who has had specialized training in high-risk obstetrics.
• Your blood will be drawn for the initial standard prenatal labs (Type and screen, CBC, Syphilis, Rubella, Hepatitis B, Hepatitis C, Varicella, HIV).
• Urine will be collected to rule out any infections and for a drug test at this visit.
• You will have a physical exam and Pap smear with cervical cultures.
• An ultrasound will be done to confirm your gestational age “due date” and to confirm that the pregnancy is in the uterus.
• You will have a return ob visit every 4 weeks starting from your first visit until 28 weeks of pregnancy.

Fetal Growth

• By the end of this month, your baby is completely formed. It weighs just over 1 ounce and is 4 inches long.
• The fingers and toes have soft nails.
• Teeth buds have formed under the gums.
• Hair may start to appear & head is large compared to body. Kidneys develop and start draining urine into bladder.
• The baby’s heart has four chambers and beats between 120 to 160 beats per minute.
• The baby may open and close the mouth and start moving the hands, legs, and head.
• At this point you will not feel movement because your uterus is still in the pelvis.

Your Health

• Your pregnancy hormone, Beta hcg, is at the highest level during this time and morning sickness may be worse.
• Continue to drink water as much as you can.
• Also remember to use ginger ale, ginger tea, ginger chews, and pretzels to help with the nausea.

Office Visit

• Routine OB visit where the provider will listen to the fetal heartbeat.
• Your urine will be examined for protein, glucose & any evidence of a urinary tract infection.
• You will also be offered part I of the Genzyme Test.  This is blood test that has two parts & is screening for Down’s syndrome, which is a common genetic disorder that can cause mental retardation and an AFP test for neural tube defects such as spina bifida. This is a screening test & only tells us if the risk is low or high; it will not reveal if the fetus absolutely has or does not have Down’s Syndrome.  A patient has the option to decline this test; we request you sign a form declining the test.
• Your office visit will be every 4 weeks

Fetal Growth

• Baby is completely formed (8-10 inches long & 6 ounces in weight) and has a strong heartbeat.
• Skin is pink & slightly transparent.
• Baby moves, kicks, sleeps, wakes, swallow, & passes urine.
• Baby’s movement is called quickening (feels like bubbles or fluttering)

Your Health

• Morning sickness should be better if not completely gone.
• Continue to be active unless otherwise instructed by your provider. Eat a healthy diet that is balanced in proteins, fats & carbohydrates.
• Your uterus will be rising in your abdomen & you may start showing.
• You may start experiencing a pulling sensation in your pelvis & this is typically called round ligament pain. This is being caused by the growth of your uterus pulling the ligaments that attach the uterus to the abdominal wall.

Office Visit

• Your provider will listen to the fetal heartbeat.
• Your urine will be examined for protein, glucose & any evidence of a urinary tract infection.
• Part II of the Genzyme test will be done (screening test for Down Syndrome)
• You can have a “Sneak Peek” to find out if the baby is a boy or a girl starting at 15 weeks
• Your office visit will be every 4 weeks

Fetal Growth

• Baby will grow very fast as the internal organs mature & baby stores fat beneath the skin. Baby is 12 inches long & weighs 1 pound (~500 grams). The head & body of the baby will be more proportionate in size.
• Fingernails have grown to tips of fingers. Baby may suck its thumb
• Baby sleeps & wakes at regular intervals
• Baby will be much more active

Your Health

• Continue to be active unless otherwise instructed by your provider. Eat a healthy diet that is balanced in proteins, fats & carbohydrates.
• Monitor your weight gain in pregnancy
• Your uterus will rise to the level of your belly button. Your regular clothes may start to not fit. Invest in some maternity clothes.
• You may start going to the bathroom more frequently as your uterus and baby gets bigger.

Office Visit

• Your provider will measure how high your uterus rises with a measuring tape & will listen to the fetal heartbeat.
• Your urine will be examined for protein, glucose & any evidence of a urinary tract infection.
• You will have an Anatomy ultrasound around 20 weeks of pregnancy. This is very detailed exam of the fetal anatomy and includes confirming the sex of the baby if desired.
• Your office visits will be every 4 weeks

Fetal Growth

• Baby continues to grow rapidly. By end of this month, your baby is 11-14 inches long & weighs 1-1 ½ pounds.
• Skin is wrinkled & red; it is covered with fine soft hair (lanugo) & vernix (a substance of oil & cells)
• Despite the fast growth of the baby, it is still small & the lungs are not fully developed. The baby cannot live outside your uterus at this stage of pregnancy without specialized care.

Your Health

• Continue to be active unless otherwise instructed by your provider. Eat a healthy diet that is balanced in proteins, fats & carbohydrates.
• Monitor your weight gain in pregnancy
• You may start experiencing some back pain as your abdomen gets bigger. Sleep with a body pillow and get an abdominal support band to help relieve the discomfort.

Office Visit

• Your provider will measure how high your uterus rises with a measuring tape & will listen to the fetal heartbeat.
  • Your urine will be examined for protein, glucose & any evidence of a urinary tract infection.
  • Gestational diabetes screen
  • • You will have your glucose (sugar) checked at this visit to make sure you do not have gestational diabetes (diabetes that develops during pregnancy).
    • You will be asked to drink a sweet drink called glucola (tastes like a very sweet Orange Crush) in less than 5 minutes and your blood will be drawn one hour after you drink the glucola.
    • You are not permitted to leave the office with the glucola drink or at any time during the hour before your blood is drawn.
    • You don’t have to fast for this test but we recommend you not eat anything for at least 2 hours before your appointment.
    • If this test is abnormal, you will need to do a 3-hour test to determine if you have gestational diabetes.
    • Your office visits will be every 3-4 weeks

Fetal Growth

• The baby continues to grow & will be 15 inches long & weighs 2-3 pounds.
• Bones of the baby harden as calcium is being stored.
• Lanugo (the fine soft hair) begins to disappear from the face & baby may have more hair on its head. Baby can open its eyes.
• Baby exercises (kicks & stretches).
• Baby has a better chance of survival if born early.

Your Health

• Continue to be active unless otherwise instructed by your provider. Eat a healthy diet that is balanced in proteins, fats & carbohydrates.
• Continue to monitor your weight gain in pregnancy
• Your back pain may worsen. Continue to use an abdominal support band if it helps with the back pain.
• Make sure to drink lots of water even though you have to go the bathroom more frequently.
• You may start having some swelling in your lower legs. This is normal because the fluid in a woman’s body increases in pregnancy. Your provider will be closely watching your blood pressure & will look for protein in your urine.

Office Visit

• Your provider will measure how high your uterus rises with a measuring tape & will listen to the fetal heartbeat.
• Your urine will be examined for protein, glucose & any evidence of a urinary tract infection.
• If your blood type is Rh negative you will be given an order to get a Rhogam shot at Piedmont Henry Hospital. This shot protects your future pregnancies against a potientally life threatening disease. Not every patient requires this shot and your provider will inform you if you need it.
• Your office visits will be every 2-3 weeks.

Fetal Growth

• Baby is too big to move around as much as before but the kicks are stronger & you may be able to see the outline of a heel or elbow on your abdomen.
• Baby is 16-18 inches long & weights 4 pounds. Baby gains about ½ pound (~250 grams) each week after 34 weeks.
• Boy babies will have their testicles descend into their scrotum at this time of the pregnancy.

Your Health

• Continue to be active unless otherwise instructed by your provider. Eat a healthy diet that is balanced in proteins, fats & carbohydrates.
• Continue to monitor your weight gain in pregnancy
• It may become difficult to sleep lying down as your abdomen gets bigger. The diaphragm (muscle that helps us breath) gets pushed up as the pregnancy progresses. You may get better sleep on your side or in a reclining position.
• Watch the swelling in your legs and/or hands. Again your provider will be closely monitoring your blood pressure and the protein in your urine.
• You may start having Braxton Hicks (irregular, false contractions). Contact the office you have regular contractions every 10 minutes or less for greater than one hour.

Office Visit”]

• Your provider will measure how high your uterus rises with a measuring tape & will listen to the fetal heartbeat.
• Your urine will be examined for protein, glucose & any evidence of a urinary tract infection.
• At your 35-week visit you will have vaginal culture done for Group B Strep (GBS). This is an organism in the genital area of some women that does not affect the mother but can cause pneumonia or meningitis in babies. If you are positive for GBS on culture or in your urine, you will need to receive an antibiotic while you are in labor to decrease risk of passing the organism to the baby.
• Your office visit will be every 2 weeks

Fetal Growth

• Your baby continues to gain ½ pound each week. It will be about 20 inches long & weights 6-9 pounds.
• Baby settles into a favorable position in preparation for birth; it will be head down against the birth canal and its knees against the nose. The bones of the head are soft & flexible for delivery through the birth canal.

Your Health

• You may have a lot of pressure in your pelvis. You may also have some nerve pain down the back of one or both of you legs. Likely this is due to Sciatica but let your provider know during the next office visit.
• You may pass your mucus plug at once or over the course of a few days. This is normal & does not mean you are going into labor right away.
• You will start having regular contractions. Contact the office if you have regular contractions every 5 minutes for greater than one hour.

Office Visit

• Your provider will measure how high your uterus rises with a measuring tape & will listen to the fetal heartbeat.
• Your urine will be examined for protein, glucose & any evidence of a urinary tract infection.
• You could go into labor any time in this stage.
• Your cervix will be checked at the office.
• If your GBS result is negative & cervix is slightly dilated, your midwife or physician may be able to strip your membranes to help with the release of prostaglandins (this will help soften your cervix).
• If you are for a c-section, you will be scheduled for delivery around ~39wks
• If you have not gone into labor on your own before your 40^th week of pregnancy you will be offered an induction of labor between the 40^th & 41^st week of pregnancy.
• Your office visits will be every 1-week