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what is happening, the development of pregnancy and fetus

Week by week
33 - 36 weeks of pregnancy
Elena Gevorkova
Obstetrician-gynecologist, Moscow

33rd week

BABY

At the 33rd week, the weight of the fetus is 1800-1900 g, and the body length is 43-44 cm. The amount of subcutaneous fat increases, due to which the folds and wrinkles on the baby's body are smoothed out, the skin turns pink. The fluffy hairs that cover the body of the fetus, which are called lanugo, become smaller, and the hair on the head darkens and thickens. The baby's skin is covered with a thin layer of cheese-like lubricant, its largest amount accumulates in the folds - axillary, cervical, inguinal - as well as on the back of the body and face. Grease is a viscous mass of white color, it is a secret of the sebaceous glands, mixed with skin scales. Its function is to protect the baby's skin from damage and facilitate its passage through the birth canal.

By this time, the movements of the fetus gradually change their habitual character - they become more and more limited and less pronounced in amplitude due to insufficient space. However, the strength of the movements increases, since by this time the muscular system of the fetus is already sufficiently strengthened. Sharp and strong tremors of the fetus can be sensitive to the internal organs of a pregnant woman. Depending on the position of the baby, the liver, stomach, bladder, ribs, etc. may “suffer”. By 33 weeks, the movements of the fetus are already quite coordinated.

FUTURE MOTHER

The height of the fundus of the uterus from the level of the pubis at this time is 34 cm. The volume of the abdomen is increased due to the weight of the baby, placenta, amniotic fluid. The increase in uterine pressure and strong tremors of the fetus can cause some discomfort in the pregnant woman. Many movements previously available to the expectant mother, such as squats, become limited. Moderate physical activity - walking, fitness, etc. - Requires frequent respite.

A change in the center of gravity increases the load on the spine, which can manifest itself as pain in the lower back, sacrum, and pelvic region. The pressure of the uterus on the stomach can cause or increase nausea, heartburn, and a feeling of heaviness. An increase of almost 1 liter of the volume of circulating blood in the body of a pregnant woman increases the load on the kidneys, and the growing uterus puts pressure on the bladder. All this can be manifested by frequent urination.

These ailments are usually associated with the mechanical pressure of the uterus on the surrounding organs; they are not symptoms of the disease and are temporary. And to relieve nausea, heartburn and a feeling of heaviness in the stomach, frequent meals in small portions are recommended.

34th week

BABY

By this time, the weight of the fetus is approximately 2100 g, and the height is 45 cm. From this period, the cheeks are very pronounced, because, developing a sucking reflex, the fetus often sucks its thumb. This leads to the fact that the baby strengthens the facial muscles, in particular the buccal. The total muscle mass of the fetus increases, the bones become denser.

There is an intensive functioning of the baby's internal organs. During the day, he repeatedly swallows portions of amniotic fluid. Passing through the gastrointestinal tract, the amniotic fluid stimulates the work of the muscular wall. The dense part of the amniotic fluid, which is a suspension of skin flakes, lubricant, vellus hair, is processed by the enzymes of the liver and pancreas, and the liquid part is intensively excreted by the kidneys of the fetus.

Approximately 500 ml of amniotic fluid is treated in this way per day. The production of bile continues, which accumulates in the gallbladder and, as the stomach fills with a suspension of amniotic water, enters the lumen of the small intestine. The functional development of the liver and pancreas during the prenatal period does not play a significant role, since the fetus does not have digestion; processes for the production of bile and enzymes: lipase, which breaks down fats; trypsin, which breaks down proteins; amylase, which breaks down carbohydrates, etc. - are preparatory in nature.

FUTURE MOTHER

Most pregnant women begin to feel rather intense false contractions at this time. Strictly speaking, false or training contractions, which are also called Braxton-Hicks contractions, can occur after the 20th week of pregnancy: the longer the period, the more frequent and pronounced the contractions. They are episodic contractions of the muscles of the uterus, lasting from a few seconds to 3-5 minutes. Braxton-Hicks contractions are not pathological - this is a completely normal process of preparing the muscles of the uterus for the difficult process of childbirth. This phenomenon with varying degrees of intensity is observed in almost all pregnant women.

Many primiparas are concerned about the difference between preparatory contractions and labor.

Here are some differences:

• Frequency of contractions. Training bouts do not become more frequent, the intervals between them may be different. Labor pains are regular, the interval between them is reduced.
• Duration of contractions. Training bouts have different durations, from a few seconds to minutes, their duration does not increase over time. Labor pains tend to lengthen.
• Soreness. Preparatory contractions may not be accompanied by pain at all, or they may be quite noticeable, up to a feeling of sharp pain. However, their intensity weakens over time and the pain disappears. Labor pains are painful and constantly intensify.
• Localization. Braxton-Hicks contractions can be felt in various places - in the lower part of the uterus, in the region of its bottom, along the side walls, covering the entire abdomen. Labor pains begin with a contraction of the lower abdomen, spreading to the front. Often in childbirth, pain in the lower back is felt, while the nature of the pain resembles menstrual pain.
• Relationship with body position. Preparatory contractions may disappear after walking or, on the contrary, rest. A change in body position can relieve the tension in some muscles, which also causes a decrease in the appearance of training contractions. Labor pains may be somewhat relieved in a certain position - when leaning forward, in the knee-elbow position, etc. - but their frequency and duration will still increase.
• Reaction to medication. The use of antispasmodic drugs - NO-ShPY, BUSCOPAN, PAPAVERIN, etc. - approved by the attending physician, can weaken or completely stop false contractions. The effect of antispasmodics on labor pains is minimal.

Any pain or discomfort should be reported to the gynecologist: this will help the expectant mother to resolve doubts and cope with anxiety. Feeling safe is the best companion of pregnancy.

35th week

BABY

The length of the body of the fetus is 46--47 cm, weight - 2200-2300 g. These figures in the last weeks of pregnancy can vary greatly. The growth and weight of the fetus largely depend on heredity, individual parameters. Starting from 35 weeks, the baby will gain 200-250 g weekly. The fetus occupies almost the entire uterine cavity, its back is rounded, arms and legs are bent, brought to the body. The layer of subcutaneous fat increases significantly, which significantly “rounds” the body of the fetus. The closing of the eyelids and the contraction of facial muscles change the baby's facial expression quite often. The skin of the body becomes pink, smooth, the amount of cheese-like lubricant begins to decrease. Vellus hair covers separate small areas of the body - shoulders, back. The nails protrude beyond the tips of the fingers.

FUTURE MOTHER

The fundus of the uterus is 35 cm higher from the pubis and 15 cm higher from the navel. particularly light. The growing uterus does not allow the lungs to expand, respiratory movements are limited, which is manifested by shortness of breath. Almost all pregnant women to one degree or another experience a feeling of shortness of breath - a feeling of lack of air, frequent and shallow breathing, a desire to take a deep breath. As a rule, these sensations occur for a period of 28 weeks and reach their peak at the 35-36th week. After 37 weeks of pregnancy, the abdomen droops, which greatly facilitates breathing.

Shortness of breath during pregnancy is associated not only with the mechanical pressure of the uterus on the diaphragm, but also with the relaxing effect of hormones on the muscles of the bronchi and lungs. Most often, it is provoked by physical activity - climbing stairs, a long walk, etc. However, it is not uncommon for shortness of breath to occur at rest, especially when lying down. Both prolonged lying in a horizontal position and excessive exercise can contribute to increased shortness of breath. To alleviate her condition, the expectant mother needs to be rational about the daily routine - it is reasonable to alternate rest and physical activity. It is important to monitor your posture, as slouching exacerbates shortness of breath, reducing the already insufficient lung capacity. If shortness of breath is accompanied by blue lips or nails, sensations of pain behind the sternum, darkening before the eyes, nausea or vomiting, fainting, then an urgent need to consult a doctor.

36th week

BABY

The growth of the fetus by this term is about 47--48 cm, and the weight is about 2300-2500 g. The fetus enters a period of intensive preparation for childbirth. Each of the organs is already functionally mature enough to ensure the viability of the fetus. 36 weeks is the beginning of the preparatory journey, and the upcoming weeks of pregnancy are designed to finally form the baby's readiness for extrauterine life.

By 36 weeks, the fetus is in its final position in the uterus. As a rule, this is a longitudinal position, occipital presentation - in this case, the fetus is located head down, facing the mother's back. This is the most comfortable position that ensures the greatest safety of the baby during childbirth. More rarely, breech presentation is a condition in which the buttocks and legs of the fetus are located at the bottom of the uterus. This is a relative indication for operative delivery. The final decision on caesarean section or independent childbirth is made by doctors in each case individually.

A change in the position of the fetus in the uterus is possible, but this happens infrequently, since at this time the fetus occupies almost all the free space in the uterus, which significantly limits its motor activity. As a rule, if a change in the position of the fetus occurs, then only from the pelvic to the head. The reverse cases - the transition of the baby from the head position to the pelvic position - are practically impossible, since the head of the fetus is heavier than the buttocks and occupies the longitudinal position completely, by analogy with a float in water, the heavy part of which always outweighs.

FUTURE MOTHER

The height of the uterus is 36 cm, the volume of the abdomen is maximally increased, the bottom reaches the costal arches. At this time, the pregnant woman's body also begins its journey of preparing for the upcoming birth. Changes begin with hormonal changes: the level of special hormones, oxytocin and prostaglandins, increases slightly in a woman. These active substances play a crucial role in the process of preparing for childbirth and directly during them. A slight increase in their level from the period of 36-37 weeks of pregnancy leads to an increase in Braxton-Hicks training contractions, an increase in urination and defecation, and the appearance of more abundant mucous discharge from the vagina.

How can you tell real contractions from training contractions?

Shemyakina Natalya Nikolaevna, head of the obstetric department of the Leleka maternity hospital , will help you figure it out.

Training contractions, or as they are also called, fake, or Braxton-Hicks contractions, are irregular contractions that do not have increasing intensity. The uterus may tone up, but normally, it should pass quickly.

For example, the tone appeared once in half an hour and the uterus relaxed rather quickly. Then the tone reappeared only after two hours and again passed. These are training contractions, they do not increase in intensity and do not become more frequent.

Training bouts are physiologically provided by our body. So the uterus is preparing to do the hard work in the process of childbirth. Normally, training contractions appear in terms of pregnancy close to childbirth - from the 37th week of pregnancy.

The appearance of training contractions in the early stages of pregnancy is not the norm

The uterus can tone up with an active lifestyle, physical activity, with a change in body position, but this tone should quickly pass. Normally, the uterus should not often come into tone. And even more so, contractions, as such, should not be until the 37th week of pregnancy.
Braxton-Hicks contractions in the early stages are a threat of preterm labor. If a woman has contractions periodically during the day: after an hour, after 2, then again after an hour, (even if they are not regular), for periods up to 37 weeks, such a tone should alert the expectant mother.
Because this is not the norm, but the threat of premature birth. This is an occasion to contact a specialist and change your rhythm of life, put on a bandage. The causes of premature birth are most often internal, caused by hormonal disorders and a violation of the physical health of a woman. But significant physical activity and stress can also cause premature birth.

Labor pains

Unlike training pains, labor pains are regular. The uterus comes to tone first once every 15 minutes, and after a while - once every 7-10 minutes. Contractions gradually become more frequent, longer and stronger. And already occur every 5 minutes, then 3 and finally every 2 minutes.

True labor pains are contractions every 2 minutes, 40 seconds. If within an hour or two the contractions intensify - pains that begin in the lower abdomen or in the lower back and spread to the stomach - most likely, these are real labor pains.

Training contractions are NOT so much painful as unusual for a woman. When the expectant mother sees how the stomach comes into tone, its shape changes and it becomes dense, like an inflated ball. This might scare you a little. But a woman must understand that in real, labor pains, there must be a clear periodicity, intensification and acceleration over a certain period of time. Real fights never stop, but practice fights do. The uterus then comes to tone, then relaxes.
Women often confuse contractions with tone, which is caused by other physiological processes in the body. For example, increased intestinal peristalsis, intestinal infections, colic, etc.

What else should alert a woman?! If within an hour or two the uterus periodically comes into tone and mucous, bloody (streaked with blood or brown) discharge appears, then most likely there are structural changes in the cervix - it opens. Also an important sign to seek help is the discharge of the mucous plug long before childbirth. Her departure in terms of childbirth, a week or two before childbirth is normal.

Tracking labor pains

There are several methods for determining the types of contractions. A woman can do this herself, writing down the frequency and duration of contractions on paper or tracking them using special programs for a computer and phone. Or you can contact a doctor at antenatal clinic or at the maternity hospital, where a specialist will conduct fetal monitoring (fetal CTG). With the help of 2 sensors, the fetal heartbeat, uterine contractions are monitored and it is determined whether these are training contractions or labor.

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