Pregnancy Week By Week (Week 18)

Week 18 Fetus

Must-ask Questions this Week (Week 18)

What should I expect at this weeks' appointment at the doctor's office?

At this month's prenatal check up you can expect your doctor to check

• The fundal height (your doctor will measure the distance between your pubic bone and the top of your uterus - the fundus)

• Your weight (to see if you are continuing to gain weight steadily)

• Your blood pressure (to spot any early warning signs of pregnancy-related hypertension or preeclampsia)

• Your urine (to ensure that your sugar and protein levels are within the normal range as they can provide clues to emerging problems)

• The fetal heart rate (to moni tor your baby's general well being) Note: your baby's heart beat beats much faster than your own - 120-160 beats per minute on average. Don't be alarmed by this as it is normal for baby's heart to beat faster than an adult.

What if I am measuring a bit large for my dates?

If you are measuring large, (normal fundal height is 18 cm plus or minus 2 cm at 18 weeks of pregnancy) your doctor may order for an ultrasound to check if you are carrying twins, if your baby is on the big side, if you have one or more large uterine fibroids (non-cancerous growths), or if you have an excessive amount of amniotic fluid. Some women measure a little large throughout their pregnancy, while others go through a temporary growth spurt (they measure large in one appointment and growth is on target at the subsequent check up). While you may get consistent fundal readings if you have the same doctor measuring your belly at the appointments, it is possible for a different doctor to get a different reading on the same day due to different method of measuring.

What if I am measuring a bit small for my dates?

If you are measuring small, your doctor will likely want to do an ultrasound or possibly a series of ultrasounds to find out the reason. It could be that your baby is temporarily lagging behind and will go through a growth spurt shortly, that you are small built and your size may be affecting the size of your baby, you are a little low in amniotic fluid, or your baby is experiencing some sort of growth restriction problem such as a problem with the placenta.

Some Basic Pointers (Week 18)

Bladder infections

One of the most common problems during pregnancy is frequent urination. Urinary tract infection (UTIs) may cause you to urinate frequently even more. UTI is fairly common. As the uterus grows larger it sits directly on top of the bladder and on the ureters (the tubes leading from the kidneys to the bladder). This blocks the flow of urine. Other names for UTI are bladder infections and cystitis. Symptoms include frequent urination, the feeling of wanting to urinate urgently, and painful urination particularly at the end of the urination. A severe form of UTI may cause blood to appear in the urine. Your doctor may do a urinalysis and urine culture at your visit. A check for your urine infection will be done periodically or when bothersome symptoms arise. You can help avoid infection by not holding your urine. Empty your bladder as soon as the urge arises. Drink plenty of fluids; cranberry juice may help you to fight infections. For some women it helps to empty bladder after intercourse. If you have UTI during pregnancy, call your doctor and take care of the problem. Research has found that risks of giving birth to a child who is mentally retarded or who will exhibit developmental delays increases when UTIs are left untreated. UTIs can also be responsible for premature labor or a low birth-weight baby. Complete the antibiotic course prescribed even if you feel uncomfortable with the idea of medication during pregnancy; the medication is safe by the way. If UTI is left untreated you will bring harm to your baby and the problem can get worse for you. It can worsen to pyelonephritis a serious kidney infection. This type of infection occurs in 1-2% of all pregnant women. Symptoms include frequent urination, a burning sensation during urination, the feeling you need to urinate and nothing comes out, high fever, chills and back pain. This condition may require hospitalization and IV antibiotics. If you contract this or have recurrent bladder problems, you may need to depend on antibiotics throughout your pregnancy to prevent re-infection.

Kidney stones

Another problem involving kidneys and bladder is kidney stones. They occur about once in every 1500 pregnancies. Kidney stones can cause severe pain in the back or lower abdomen. There may even be blood in the urine. Treatment is possible with medication and plenty of fluids. In this way the stone may be passed without a surgery or lithotripsy (an ultrasound procedure).

Backache

Nearly every pregnant woman suffers back pain during pregnancy. Some may feel it earlier while some experience it when they get heavier. Some go through pain after excessive exercise or some form of physical activity that involves bending, lifting or standing for long. Some women need to take special care when getting out of bed or getting up from a sitting position. In severe situations some women cannot even manage walking. A change in joint mobility may contribute to the change in your posture and may cause discomfort in the lower back. This is especially true in the later part of pregnancy. Your growing uterus moves your centre of gravity forward over your legs which can affect the joints around the pelvis. All your joints are looser. Hormones are another reason. However discomfort may be due to more serious problems such as pyelonephritis or a kidney stone. Check with your doctor if your back pain is too severe. The following tips may help and try them early in your pregnancy.

• Watch your diet and weight gain

• Continue walking within guidelines

• Get in the habit of sleeping on your side

• Find time to get off your feet and rest on your sides for 30 minutes

• Take a nap when your other children are napping

• Use heat on the area causing you pain

• Use a pain killer recommended by your doctor

• If pain is unbearable consult your doctor


Exercise in the Second Trimester

As your uterus grow and your abdomen gets larger, your sense of balance is affected. You may feel clumsy. This isn't the time for contact sports such as basketball or sports where you might fall easily and injure yourself or be struck in the abdomen. Pregnant women can be involved in exercise throughout their pregnancy. Exercise and staying active benefits pregnant women, contrary to traditional beliefs of yesteryears. Discuss this at your prenatal visit with your doctor if exercise is safe for you. If your doctor gives you the OK, engage in activities that are less intense and limit your time spent on workouts; listen to your body - it will tell you when to slow down. Below is the list of activities and how it will affect you in your second and third trimester.

• Swimming can be good for you. The support and buoyancy of the water can be relaxing. If you swim, swim throughout your pregnancy. If you can't swim but don't mind exercising in shallow end of the pool, you can continue this throughout your term as well. This is an exercise you can start at any point of your pregnancy so long you don't overdo it.

• Bicycling is safe if you are comfortable with it and have safe places to ride. Your balance will change as your body changes. This can make getting on and off a bicycle difficult. A fall can injure you or your baby. A stationary bicycle on the other hand is preferred; you can use it even in bad weather. Many doctors advise you to ride a stationary bike over a normal bike in the last 2-3 months of pregnancy to avoid the danger of a fall.

• Walking is a desirable exercise during pregnancy. It can be a good time for your and your partner to take walks together and talk. Even when the weather is not right, you can walk indoors in a shopping mall to get a good workout. Two miles at a good pace is good enough. As pregnancy advances, you may need to decrease your speed and distance. Walking is an exercise you can begin at any time; so long you don't overdo it.

• Jogging may be permitted during pregnancy but check with your doctor first; if you have a high risk pregnancy then jogging is not for you. Wear comfortable clothes and supportive shoes with good cushioning. Allow plenty of time to cool down. You will probably need to slow down and decrease your mileage. You can also alternate jogging with walking. If you notice pain, contractions, bleeding or other symptoms during or after jogging call your doctor immediately.

Your Nutrition (Week 18)

Iron is important during pregnancy; about 30mg a day is required to meet the increased needs caused by the increase in blood volume. Your baby draws on your iron store to create its own storage for the first few months of life. Most prenatal vitamins contain sufficient iron to meet your needs. If you must take supplements take it with a glass of orange juice or grapefruit juice to increase its absorption. Avoid drinking milk, coffee, tea or colas when taking iron supplement or eat iron rich foods. They prevent body from absorbing iron it needs. If you feel tired, have problems concentrating, suffer from headaches, dizziness or indigestion or if you get sick easily, you may have an iron deficiency. An easy way to check is to examine the insides of your lower eyelid. If you are getting enough iron, it should be dark pink. Your nail beds should be pink too. Only 10-15% of iron you consume is absorbed by the body. Your body stores it properly but you need to restock it daily to maintain the stores. Foods that are rich in iron include chicken, red meat, organ meats (kidney, liver, heart), egg yolks, dried fruit, spinach, kale and tofu. Combining a vitamin C food and an iron rich food ensures better absorption by the body. A spinach salad with orange juice is a good example. Your prenatal vitamin contains about 60mg of iron. If you eat a well balanced diet and take your prenatal vitamin daily, you will not need to rely on supplements. Still, discuss with your doctor if you have any concerns.