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Pregnant With Danger | PSNet

The Case

A 35-year-old woman, 38 weeks pregnant, presented to the emergency department (ED) in the middle of the night complaining of left leg pain. She also had some mild lower back pain, but no other symptoms. Hospital policy stated that all patients greater than 20 weeks’ gestation should go directly to labor and delivery unless their problem was clearly unrelated to the pregnancy. At ED triage, the pain was deemed to be non-obstetrical in nature, and so she was evaluated in the ED rather than being sent to labor and delivery.

Physical examination revealed her left leg was slightly cooler than the right leg but was otherwise unremarkable. A Doppler venous ultrasound revealed no evidence of deep venous thrombosis, but there appeared to be decreased blood flow to the leg in the left-lying position with normal blood flow in other positions. After many hours of evaluation and observation in the ED, the pain was diagnosed as musculoskeletal. To facilitate evaluation by her obstetrician, she was transferred briefly to labor and delivery. Fetal monitoring was normal and the patient was discharged home.

The following morning, the patient’s husband found her dead at home. An emergency cesarean section was performed in the ED, but both the mother and the infant expired. Autopsy revealed a ruptured aortic dissection.

This case illustrates the frequent challenges that practitioners and institutions face in caring for pregnant women, who often present to EDs with complaints that may or may not be obstetrical in nature. Optimal evaluation of a pregnant woman with a non-obstetrical complaint requires an understanding of the physiology of pregnancy and possible pregnancy-related conditions. Just as essential, though, are a structured, systematic approach to caring for these patients, and open, clear lines of communication between obstetrical and emergency physicians.

Although aortic dissection is an uncommon disorder in a woman of childbearing age, it is a potentially lethal condition and so it should be kept in mind in patients with compatible presentations. In this case, the diagnostic challenges were made even greater by a relatively unusual presentation, even for a disease that often presents with non-specific symptoms and signs. Aortic dissection is thought to result from a tear in the intima of the aorta often associated with degeneration of the media from age or other predisposing conditions. Young women who do develop aortic dissection generally have a risk factor for the disease, such as Marfan’s syndrome, Ehlers-Danlos syndrome, hypertension, or bicuspid aortic valve. Pregnancy has been considered by many to be a risk factor, and some have estimated up to half of all dissections in women younger than 40 occur during pregnancy, typically in the third trimester.(1) A recent review suggests that pregnancy’s role as a risk factor may be overstated.(2,3)

The clinical presentation of aortic dissection varies and depends on the location and acuity of the dissection. Of more than 1,000 patients with aortic dissection included in a large registry, 76% of patients had chest pain as a presenting symptom, 55% had back pain, and 18% had migrating pain.(4) The mediastinum was widened on chest radiograph in 60%.(4) The pain is often described as ripping or tearing in nature. Ten percent of patients present with isolated leg ischemia as the initial symptom of an aortic dissection.(5) The location of the pain may help determine the location of the dissection (e.g., anterior chest pain is associated with dissection of the ascending aorta, neck and jaw pain with the aortic arch, pain in the interscapular area with the descending thoracic aorta, and pain in the lumbar area or abdomen with involvement below the diaphragm). When the integrity of one of the branches of the aorta is compromised, ischemic manifestations usually follow.(1) Dissection into the iliac or femoral artery probably caused this patient’s leg pain.

Little published data describe the clinical presentation of aortic dissection in pregnancy. The presentation of aortic dissection with initial symptoms of chest or back pain is similar between genders, though some suggest that dissection in women may be less likely to present with abrupt onset of pain.(6) Pregnancy-related dissection was rare in a group of more than 300 women with aortic dissection.(2) Degeneration of the collagen and elastin in the aortic media is considered a predisposing factor for dissection. This, together with increased wall stress from hypertension or valvular abnormalities (bicuspid aortic valve), is presumed to lead to intimal tear and dissection. Hypertension has been associated with 25% to 50% of cases of aortic dissection in pregnant women. The proximal aorta is the most common site of pregnancy-associated aortic dissection, with an intimal tear originating within 2 cm of the aortic valve in 75% of cases. (7) The aortic tear commonly occurs during the third trimester or during the first stage of labor.(8) It should be noted, though, that maternal and fetal mortality from aortic dissections in pregnancy have decreased substantially in the past two decades.(1)

Given its rarity and this atypical presentation, it is not entirely surprising that the diagnosis of dissection was missed in this patient. Nevertheless, some problems occurred in the triage and early management of this patient, and they help shine some light on more general safety issues regarding caring for pregnant patients with both obstetrical and non-obstetrical medical conditions. Five general principles should be addressed when developing a systematic approach to triage, evaluation, and management of urgent conditions that occur during pregnancy.

1. Presenting Complaint Pregnant women can present with a myriad of complaints, making appropriate triage challenging. Complaints that clearly are obstetrical (e.g., episodic lower abdominal pain consistent with uterine contractions) should be triaged directly to the labor and delivery unit. However, presenting complaints that are non-obstetrical in nature or not clearly obstetrically related (e.g., chest pain, acute shortness of breath, leg pain) should be triaged depending upon the individual institution’s resources, consultant availability, and access to diagnostic testing. For example, a pregnant patient with acute chest pain or sudden shortness of breath may be more appropriately evaluated in the ED where there is often better access to diagnostic imaging than in labor and delivery. In contrast, pregnant patients in the second or third trimester with pregnancy-related complaints would be better served with an evaluation in labor and delivery. In either situation, clear communication between the emergency physician and obstetrician is important. Some examples of presenting complaints in pregnant women are included in Table 1 and may help guide an institution in developing a triage policy.
2. Availability of Consultant/Clinical Expertise For obstetrically related issues, the availability of consultants and clinical expertise typically resides within labor and delivery. However, in other circumstances, such as presentation with leg pain, the expertise of the emergency physician and the rapid availability of consultants may make the ED a more appropriate setting for evaluation. Depending upon the health system’s structure, these resources may be equally available in the labor and delivery setting. Local administrators and clinical leaders should carefully evaluate their own consultant availability to determine how best to develop the system for triage depending upon availability of consultant and clinical expertise.
3. Timeliness of Testing Access to advanced imaging and testing should also help guide the development of institutional policies. In many settings, diagnostic testing such as computed tomography (CT) scanning or ultrasound is most expeditiously performed through the ED, whereas in others, an inpatient unit such as labor and delivery may be most effective. Exposure to radiation has always been a special concern during pregnancy. Fetal exposure is generally not a concern until 5 Rads (5000 mRad) of exposure has occurred. A CT scan of the abdomen typically results in 150-200 mRad fetal exposure, whereas a CT of the abdomen and pelvis delivers approximately 2000 mRad to the fetus.(9) In other words, concern about fetal radiation should not stand in the way of appropriate diagnostic evaluation.
4. Need for Fetal Evaluation Most pregnant women with urgent or emergent complaints, unless clearly of no threat to the fetus, will undergo formal fetal monitoring. In most circumstances, fetal evaluation is done most expeditiously and thoroughly in a labor and delivery setting. However, maternal circumstances sometimes require prolonged stay in an ED (e.g., evaluation of multiple system trauma). In those circumstances, depending upon the viability of the fetus and the capabilities of the individual health system, arrangements for fetal evaluation should be made in the ED. Policies should be developed to assure the availability of appropriate clinical skills and equipment for continuous fetal monitoring in the ED when needed. Every ED should have the capacity to assess fetal heart rate, at a minimum by handheld Doppler. In an ED where a pregnant woman may require a prolonged stay, a protocol to provide fetal monitoring with appropriately trained personnel interpreting the monitor tracings should be developed. This can be accomplished by having a fetal monitor and labor and delivery nurse come to the ED, or, as in our institution, fetal monitoring initiated in the ED with remote interpretation of the monitor in labor and delivery.
5. Gestational Age at Presentation Some diagnoses are limited to certain timeframes in pregnancy and must be considered in the initial evaluation. For example, ectopic pregnancies most commonly occur between 5 and 10 weeks’ gestational age. However, they may occur as late as 14 to 15 weeks in interstitial (cornual) pregnancy. Women who present at or near the point of fetal viability (approximately 23 to 24 weeks) require special consideration, because they could require immediate fetal evaluation and potential delivery. Building a policy for triage and transfer between the ED and labor and delivery requires consideration of gestational age. For example, if a pregnant woman at 22 weeks’ gestational age presents to the ED with vaginal bleeding and has stable vital signs, she would be transferred to labor and delivery (see Table 2, scenario III). Nursing-to-nursing communication should take place at the time of transfer to assure transmission of information (presenting complaint, vital signs, etc.).

The University of Michigan (a tertiary referral center) has developed a triage protocol for obstetrical patients presenting to the ED (Table 2). In the present case, the patient would fall into Category V (medical complaint not related to pregnancy, greater than 20 weeks' gestation) and would be evaluated in the ED. Careful attention to the differential diagnosis, appropriate consultation and the judicious use of diagnostic testing (e.g., CT scan) might have detected the aortic dissection before the discharge and subsequent tragic outcome. When resources and consultants are available, this system works well, but it would not work as well for a hospital without available obstetrical consultants. Nevertheless, even in such hospitals, it can be used as a general guide in developing institutional policies.

The mother and fetus in this case suffered a tragic outcome at a hospital that appeared to lack a structured protocol for triaging obstetric patients. It is unclear whether the outcome would have been different elsewhere. This case highlights the need to create clear guidelines for urgent management of pregnant patients and to maintain clear lines of communication between providers.

Take-Home Points

• Aortic dissection is a rare complication of pregnancy but carries substantial risk of morbidity and mortality.
• Institutions should establish structured protocols for the triage of obstetrical patients presenting with emergency complaints.
• In developing protocols, hospitals must consider many factors, including the nature of the complaints, consultant and testing availability, the need for fetal monitoring, and the fetal age.

Mark D. Pearlman, MD Professor and Vice Chair, Department of Obstetrics and Gynecology Professor of Surgery University of Michigan Medical Center

Jeffrey S. Desmond, MD Clinical Assistant Professor and Service Chief Department of Emergency Medicine University of Michigan Medical Center

References

1. Lewis S, Ryder I, Lovell AT. Peripartum presentation of an acute aortic dissection. Br J Anaesth. 2005;94:496-499. [ go to PubMed ]

2. Nienaber CA, Fattori R, Mehta RH, et al. Gender-related differences in acute aortic dissection. Circulation. 2004;109:3014-3021. [ go to PubMed ]

3. Oskoui R, Lindsay J Jr. Aortic dissection in women go to PubMed ]

4. Januzzi JL, Marayati F, Mehta RH, et al. Comparison of aortic dissection in patients with and without Marfan's syndrome (results from the International Registry of Aortic Dissection). Am J Cardiol. 2004;94:400-402. [ go to PubMed ]

5. Pacifico L, Spodick D. ILEAD--ischemia of the lower extremities due to aortic dissection: the isolated presentation. Clin Cardiol. 1999;22:353-356. [ go to PubMed ]

6. Konishi Y, Tatsuta N, Kumada K, et al. Dissecting aneurysm during pregnancy and the puerperium. Jpn Circ J. 1980;44:726-33. [ go to PubMed ]

7. Immer FF, Bansi AG, Immer-Bansi AS, et al. Aortic dissection in pregnancy: analysis of risk factors and outcome. Ann Thorac Surg. 2003;76:309-314. [ go to PubMed ]

8. Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest. 2002;122:311-328. [ go to PubMed ]

9. Goodsitt MM, Christodoulou EG. Diagnostic imaging during pregnancy: risks to the fetus. In: Pearlman MD, Tintinalli JE, Dyne PL, eds. Obstetric and Gynecologic Emergencies: Diagnosis and Management. New York, NY: McGraw-Hill; 2004:535-548.

Tables

Table 1. Case Examples

These cases are included to test how an institution’s ED triage policy would handle a variety of different types of patient presentations. One way to use these cases would be for both ED and OB service chiefs to review them, determine how they would handle the triage of these patients, and be certain that the expectations and outcomes of the triage are similar. 21-year-old G2P1 presents to ED with a positive pregnancy test at 7 weeks’ gestation, 2 days of right lower quadrant pain, and no intrauterine pregnancy on vaginal probe ultrasound. 26-year-old G2P1 was involved in high-speed motor vehicle crash at 34 weeks’ gestation. EMS calls and notes obvious deformity in right lower extremity and vaginal bleeding. 17-year-old G1P0 with a positive home pregnancy test today presents with heavy vaginal bleeding, pulse of 130, and BP of 68/40. 33-year-old G3P2 presents at term in labor with the presenting part visible at the introitus. 34-year-old G3P2 at 22 weeks’ gestation with fever and epigastric and right upper quadrant abdominal pain for 5 hours after eating a greasy meal. 28-year-old G2P1 at 25 weeks’ gestation slips and falls on ice, twisting her ankle and landing on her buttocks. She has ankle pain without deformity.

Table 2. Triage Guidelines for Obstetrical Patients Presenting to the Emergency Department (Adapted from University of Michigan Hospitals and Health Centers Emergency Department Guidelines)

All patients who present to emergency department triage will have a triage assessment completed and documented prior to labor and delivery (L&D) transfer

This project was funded under contract number 75Q80119C00004 from the Agency for Healthcare Research and Quality (AHRQ), U. S. Department of Health and Human Services. The authors are solely responsible for this report’s contents, findings, and conclusions, which do not necessarily represent the views of AHRQ. Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the authors has any affiliation or financial involvement that conflicts with the material presented in this report. View AHRQ Disclaimers

38 weeks of pregnancy ► Your pregnancy, week by week

Here is the 38th week of pregnancy, which means that the baby is 38 weeks old, and perhaps he has already been born 🙂 In this case, we can only congratulate you and wish him health and many interesting events in life!

And if you are still waiting for his appearance... The child now weighs about 3 kg with a height of 49 cm. And his weight will increase until delivery. The uterus, in which he now lives, has risen 16-18 cm above the navel, but by now the tummy has already managed to drop a little. Your weight gain is from 10 to 14 kg, and if you want him to quickly return to your usual indicators after childbirth, try to eat often and in small portions. Of course, only the right products should be on the menu. Well, if now you give preference to cereals cooked in water, boiled meat and vegetables, give up sweets and pickles (if you haven’t done this before). nine0003

Despite the fact that the placenta continues to provide the child with everything necessary, its main functions begin to fade, and it itself “gets old”. Everything that the baby now receives from the mother is aimed at its growth. Therefore, it is extremely important for you to provide your body with the necessary components that are contained in the Pregna-5 complex.

At the 38th week of pregnancy, the cervix becomes shorter, it opens up so that the baby can come out. In the meantime, it puts a lot of pressure on the bladder, forcing you to run to the restroom every now and then. To all other sensations, which either became easier or worsened throughout the pregnancy, at this stage, pain in the sacrum may be added. If, along with these sensations, your stomach began to sip, this indicates the imminent onset of childbirth. nine0003

At 38 weeks of pregnancy, the pelvic bones continue to move apart, the joints become more mobile, and the cartilage and ligaments become softer. The baby's head is now pressing on the nerve endings, so you can feel sharp pains in the legs and perineum.

Training contractions become more active, and in order not to confuse them with real ones, remember: during real contractions, their frequency and strength increase. In addition, water leaves with them, and a mucous plug comes out a few days before or on the day of birth. Pay attention to the discharge: if you notice an admixture of blood, call the doctor. Remember also that your task is to ensure the purity of the birth canal so that the baby does not catch an infection during the birth! nine0003

The 38th week of pregnancy is a time when the legs and arms can swell, especially after a long stay in one position. By this point, stretch marks may have appeared, but if you take care of your skin with special products, there is a chance that it will recover faster and stretch marks will be less noticeable.

The breast has become larger, its sensitivity has increased, veins appear on it. Colostrum can be intensively secreted. However, if it is not present, this is not a cause for concern - it does not and will not affect your ability to feed your baby. nine0003

A bit about close relationships with her husband, which many expectant mothers avoid for some reason. If you have a desire and the doctor does not forbid, you can spend time together. Moreover, sexual relations at the 38th week of pregnancy are useful for the expectant mother if both she and the partner do not have health problems.

38th week of pregnancy: information about the baby

Perhaps in the next few days he will make his first cry 🙂 By the way, some babies do not cry, but make a strange and not quite loud sound. In such cases, doctors slap them on the bottom to make the silent ones scream. nine0003

And after birth, he will receive the first grades in his life: they are given by neonatologists on the Apgar scale after a thorough examination of the baby. Those who received 7-10 points can be considered excellent students!

Your child now has rather hard cartilages of the nose and ears, fingerprints and the skin pattern on the heels has become clearer. The child perfectly mastered the sucking and grasping reflex, and his muscles got stronger! The skin smoothed out, became rosy. He is a very cute fluff! nine0003

The baby can open his eyes, he has grown hairs, but their color may change after birth. Many children are born blonde, and over the years they begin to darken. The child's nails have grown and he can even scratch them. Don't be surprised if you find a few scratches during your first meeting!

At 38 weeks pregnant, he may move less. In general, at 9 months, the baby is not as mobile as before, since he literally has nowhere to turn around. He loves to touch everything that is around him, and sometimes playfully beats his mother with his legs. nine0003

Count your baby's movements: they should normally be at least 10 in 12 hours. He listens to you, rejoices when you talk to him, responds to strokes and attention in his own way. His mood depends on yours, remember this when you indulge in melancholy.

Most likely it has already taken its place “at the exit”, and the relaxin produced by the mother’s body makes the pelvic ring softer and prepares you for childbirth.

Key Recommendations

If you started nesting last week, the process can continue now. If putting things in order brings you pleasure - why not? nine0003

Going through and sorting things out, you can see if you forgot to prepare anything for the arrival of the baby. By the way, now, before the birth of a child, you can record a video message, which in the future will be reviewed with him! Can you imagine the range of feelings that will be in years to come?

Think through all the possible scenarios, if you have frightening questions, give yourself answers to them. For example, many women are worried about what will happen if childbirth begins when there is no husband or relatives nearby, or even right on the street. If you play all possible scenarios, it becomes much easier! nine0003

Spend time doing something that brings you pleasure! Talk to your child : although he does not understand words, he can distinguish intonation perfectly. He is also worried, so support him, do not make him worry and nervous.

At the 38th week of pregnancy, the doctor will look at the height of the uterine fundus, the size and position of the baby, listen to his heartbeat, and send you for a general urine test. Additional tests may be ordered if necessary.

Pregnancy is coming to an end, and you and your partner are waiting for a lot of new experiences. Do not forget that in addition to being a mother, you have to be a wife and girlfriend for your man. Children very subtly feel when “something is wrong” in the family, this affects their sense of self and success. nine0003

Spend time with your husband without a child every day, communicate with him. Mom should be “enough” for everyone. But you will definitely succeed! :)

harbingers of childbirth in multiparous and primiparas, what happens, fetal movement, baby's weight, ultrasound

What happens to the baby at this time?

Now the child's weight is 3000-3200 g. Sometimes a mother can feel in the abdomen not only the fetus moving, but also rhythmic tremors - this is the child hiccups, swallowing amniotic fluid. It is believed that hiccups are a kind of training before the start of spontaneous breathing. By this time, the baby has already taken its final position in the uterine cavity - head down, towards the exit from the uterus. The obstetrician determines the presentation of the fetus by probing the abdomen of the expectant mother. But sometimes doctors detect breech presentation, in this case, an examination is performed, ultrasound is performed and the tactics of childbirth are determined. nine0003

Index

Norm

Weight gain of the mother

From 8.6 (with initial excess weight) to 14.5 kg (with initial weight deficit), average gain 10-12 kg

Fundal height03

35-38 cm

Fetal weight

3000-3200 g

Fetal height

48-52 cm

Important!

During the 38th week of pregnancy, the body of the expectant mother is actively preparing for the upcoming birth. It is important to know in advance, read the necessary information about this process (if you have not already done so) in order to clarify how to behave with the onset of contractions. nine0003

The first harbingers of childbirth appear in multiparous and primiparas. These are body changes, certain processes that set up the body and reproductive system for the birth of a child. The signs differ slightly depending on whether the mother is expecting her first baby or if this is her second and subsequent pregnancies.

Many mothers are afraid to miss or not recognize these important "calls". Don't worry about that - we've put together a handy labor checklist to help you figure out when it's time to go to the hospital. nine0003

During this period, drops of a yellowish-whitish liquid - colostrum - can periodically be released from the nipples of the breast. So the mammary glands prepare for childbirth and subsequent feeding of the baby. In order not to stain the linen, you can use special absorbent pads for the chest. They are sold in pharmacies and children's stores, they are a small circle of absorbent materials that is inserted into a bra. If colostrum is absent, this is not a sign of pathology. In some women, the work of the mammary glands starts only after the birth of the crumbs. nine0003

Harbingers of childbirth in women expecting their first child

One of the first signs that labor is coming is easier breathing due to the fact that the stomach has drooped. This feeling is not always so vivid that the pregnant woman herself notices it, sometimes others focus on it. Although the child is also actively moving, the mother's shortness of breath decreases, breathing becomes easier, heartburn and mild nausea after eating less often occur or completely disappear. But due to the fact that the fetal head sank lower into the small pelvis, the uterus is increasingly in good shape, urination becomes more frequent due to pressure on the bladder. nine0003

Sometimes the mother-to-be suddenly notices that the child is not moving much, his movements are not so sharp and active, he seems to calm down. This is a completely natural process, since every day there is less and less space inside the uterine cavity, the walls of its temporary “house” put more and more pressure on the arms and legs, tightly cover, and the amniotic fluid becomes a little less.

If the baby began to move less, he is also preparing for childbirth, gaining strength, but if for 10-12 hours you have not felt a single push or movement, it is better to consult a doctor. He will check if everything is fine with the baby. nine0003

Important!

If the mother feels the fetal movements are excessive, a doctor's consultation is necessary. This is necessary to make sure that the crumbs do not have oxygen starvation, and the volume of amniotic fluid is normal.

If in earlier periods fetal movements were felt as various movements, pushes, kicks and even somersaults, then by this time more and more often it is pandiculation or slight movements. There is already little space for the baby, sometimes his movements are very noticeable - the woman notes that she is pulling her stomach in the area where the activity of the fetus is felt. nine0003

Preparing the body for childbirth

The 38th week of pregnancy is a period of active restructuring of the body. Under the influence of hormones, the body prepares for hard work: there is pain in the lower back, pulling the lower abdomen, there is an ache in the area of ​​​​the pubic joint (the place where the pelvic bones are closed). The lower abdomen hurts due to the descent of the fetal head and its tight fit to the pelvic bones, the occurrence of more and more frequent training uterine contractions and the gradual loosening of the ligaments. Sometimes there is a feeling that the stomach is turning to stone - this is the tone of the uterus, muscle training for subsequent contractions. If these contractions are irregular, occur occasionally, they are not intense, you just need to lie on your side, rest, and they pass. If the same time passes between contractions, they become more and more sensitive, the interval is reduced - this is the beginning of labor, it's time to go to the maternity hospital. nine0003

There is one easy way to tell if contractions are false or true. You just need to count the number of contractions and the interval between them. Use a stopwatch on your smartphone, noting how long the contraction of the uterus lasts and how long the period of relaxation, rest, will then be. If the contractions of the uterus gradually increase, intensify, and the time intervals between them gradually decrease, this is a sign of the onset of labor. Then it was time to go to the maternity hospital. nine0003

Mucous discharge from the genital tract may occur during the 38th week. By the nature of the discharge, they look like lumps of dense transparent or whitish mucus with streaks of blood without any smell. This is the discharge of the mucous plug, which closed the cervix and prevented the penetration of pathogenic bacteria to the fetal membranes. The cervix gradually softens, opens slightly and the mucus gradually leaves.

Good to know

In nulliparous women, the harbingers of imminent labor may appear approximately one to two weeks before the onset of labor. It's about 38 or 39th weeks of pregnancy.

In some cases, the mother-to-be may have loose stools at 38 weeks of gestation, although no changes in the woman's diet have occurred. This is an acceptable bowel reaction to changing hormone levels and preparing the body for childbirth. The intestines are gradually cleared of the contents. However, not always different sensations and changes in the work of digestion are explained precisely by prenatal changes. Diarrhea at this gestational age may also be the result of dietary errors, food poisoning, or other influences. nine0003

A particularly alarming situation is when nausea and even vomiting occur against the background of diarrhea. In this case, you should immediately consult a doctor.

Harbingers of childbirth when expecting a second and subsequent children

If this is not the first pregnancy and childbirth for a woman, and the family is expecting a second, third baby, then the birth may come a little earlier. The body already knows what will happen and it takes less time for the preparatory phase. Thus, the appearance of the crumbs into the world can be expected in the period from the beginning of the 38th week of pregnancy. The processes themselves, which are associated with the preparation for childbirth, may not be so pronounced, sometimes they are absent or appear just a couple of days before the baby is born. nine0003

So, with repeated pregnancy, there may not be a pronounced and significant lowering of the abdomen. Often, the baby is initially located lower than during the first pregnancy, or the cervix relaxes just before the onset of childbirth. Then the woman feels that it has become easier to breathe, the pressure on the bladder has increased.

Important!

It is worth emphasizing that in multiparous mothers, the harbingers of childbirth may be completely absent. The birth process can begin suddenly, and the contractions will be stronger, the duration of labor will be shorter. Therefore, by the time of 38 weeks, you need to collect everything you need to go to the maternity hospital, all the necessary things and documents should be in an accessible place. nine0003

Childbirth is unique, it takes place differently in women, and even in the same woman childbirth is different. If this is the third birth or the fourth, often the precursors can be barely perceptible or completely absent. And the birth act itself proceeds quite quickly and sometimes even a little earlier than the date of birth, which is determined by the doctor. But, as for the second birth, this fact is not a strict pattern, childbirth is possible almost the same day with a pre-calculated date.

In any case, by the 38th week of pregnancy, it is necessary to collect everything necessary for a trip to the maternity hospital and immediately seek medical help at the first contractions. nine0003

Is it worth it to speed up labor at this time?

Many women experience fatigue towards the end of their pregnancy and want to have a baby as soon as possible. Therefore, they ask one question - how to speed up the onset of childbirth, is it possible to stimulate this process in order to meet the baby faster and return home, accept congratulations and raise the baby. But you don't need to think about inducing labor before the full term of 40 weeks. Although by the 38th week the baby is already full-term, he is still gaining weight, continues to develop, and nature knows better when he needs to be born. nine0003

• 1. Normal pregnancy (clinical guidelines) // Obstetrics and Gynecology: News. Opinions. Learning. 2020. No. 4 (30).
• 2. Burkitova A.M., Prokhorova V.

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