Women's Healthcare Topics
James Brann, MD. Ob/Gyn

27 Weeks Pregnant

Pregnant Belly Changes

At 27 weeks pregnant, your second trimester is quickly coming to a close. You only have a week more until you are in your third trimester of pregnancy! As you approach this final mile marker, you may notice that some of your old pregnancy symptoms are coming back, such as fatigue!

You've had several weeks without this tiring symptom, but now that you are in pregnancy week 27, your fatigue and exhaustion will come back with full force. As you near your third trimester, the extra weight of your baby, as well as other pregnancy symptoms (such as late night leg cramps, frequent urination, and insomnia) can also make you feel more exhausted.

Frequent urination becomes more of a problem now and in the third trimester. As your baby gets larger and takes up more room in the uterus, this adds pressure on your bladder, making it feel full even though you just went to the bathroom ten minutes ago. This is no fun especially if you are getting up several times during the night to void.

As your exhaustion and fatigue returns, you may also develop another annoying pregnancy symptom - leg cramps. Leg cramps during pregnancy make it difficult for you to sleep.

You may be dozing off peacefully when a painful leg spasm wakes you up. Your leg cramps may also be accompanied with a jumpy sensation in your legs. Unfortunately, these leg cramps occur mostly at night, but they can sometimes occur during the day.

Experts don't know what causes this symptom, but it may be due to the pressure of your heavy uterus aggravating the blood vessels that return blood from your legs to your heart, and from pressure on the nerves in the spine.

Whatever the cause of leg cramps during pregnancy, they are a bothersome symptom that can make your second and third trimester more exhausting than they should be.

You may be able to prevent leg cramps by the following techniques:

1. If possible, avoid standing for extended periods of time. You may also want to avoid sitting with your legs crossed.

2. Throughout the day, you should do routine stretches of your calf muscles. You should also stretch these muscles before you go to bed.

3. When it's time to rest, you should lie on your left side to help the blood circulate from your heart to your legs and vice versa.

4. Keep hydrated throughout the day. Drink plenty of water and fluids.

If you do end up getting a leg cramp or spasm, you may get some relief by flexing your foot or leg, and gently massaging the painful area.

Although leg cramps are normal at the end of the second trimester, you will want to call your doctor or healthcare provider if your leg pain is accompanied by reddening or swelling in the leg. This may be a sign of a blood clot and will need to be treated immediately.

Weight Gain

Fatigue will be a part of your life as you continue to gain weight in pregnancy. Your pregnancy weight gain at 27 weeks may be around 19 to 20 pounds for the average-sized woman.

Although pregnancy weight gain will fluctuate from woman to woman, it’s important that you gain the right amount of weight for your body type. This will protect the health of you and your baby. If you don’t gain enough weight, you are at increased risk of delivering a smaller. On the other hand, if you gain too much, not only will this increase your fatigue, but you are at risk of delivering a very large baby. Gaining too much pregnancy weight also places you at risk for premature labor, diabetes, high blood pressure, varicose veins, and a host of other problems.

Pregnancy Health Section

Over-the-Counter Medicines during Pregnancy

When it comes to medicines, over-the-counter, or OTC, means you’re able to buy it in a store or pharmacy without needing a prescription from your doctor. OTC medicines may take the form of a pill, eye drop or cream.

Usually, people use over-the-counter medicines to treat things like a cold and cough, a fever, heartburn, hives or skin rashes, constipation or diarrhea, or allergies. While certain OTC medicines may help cure what is behind the symptoms, many of these types of medicines can’t cure the condition at all. Rather, they help improve the symptoms you’re having over just a short amount of time.

Some OTC medicines are not safe during pregnancy, while some may be. It depends on a couple of things. The first is the medicine, itself. Ask you doctor which medicines you definitely need to avoid during pregnancy because they could cause certain problems or even harm your baby. The problem with OTC medicines, though, is that even medical experts don’t always know the answer when it comes to safety during pregnancy. There haven’t been enough safety studies on most of the OTC medicines out there regarding pregnant women.

The other consideration has to do with how far along you are in your pregnancy. The first few months of a pregnancy are when most birth defects happen. If you do take OTC medicine during the first few months, it’s more likely the medicine could hurt your unborn child.

When it comes to safety regarding OTC medicine in a pregnancy, always ask your nurse or doctor before taking it. There’s also a free hotline in the United States that offers information regarding pregnancy and certain medicines. The MotherToBaby hotline is 1-866-626-6847.

As for the best pain-relieving medicine to take during pregnancy, most doctors recommend women take acetaminophen, under the brand name of Tylenol. If you want to take any other pain medicines, you should talk to your doctor first. If acetaminophen doesn’t seem to help your headache in the final half of your pregnancy, call your nurse or doctor. You may be experiencing signs of a more serious problem than simply a headache.

Most doctors recommend that pregnant women avoid “NSAIDs”. These would be aspirin or ibuprofen under the brand names of Motrin or Advil. Also, avoid naproxen, commonly sold under the brand name of Aleve. This is especially important to remember during the final three months of your pregnancy. These types of drugs could cause certain problems during your labor or even harm your child.

The best thing you can do for constipation during pregnancy is to add fiber into your diet. You can also consider adding in a fiber supplement. If neither of these two options seems to help, talk to your nurse or doctor about taking a “laxative”. This type of medicine will help end the constipation with bowel movements.

Ask your doctor or even at the pharmacy questions about which of the OTC medicines you can safely take before you need them. Along with choosing a safe medicine, choose one that only treats the condition or symptoms you need it to. If you have any old expired medicine that may no longer be good, throw it out.

Preterm Labor - Beyond the Basics

Preterm labor is the largest reason for going to the hospital before your due date. When you think you are in early labor your physician will perform the following tests to see if you are at risk for actually delivering early:

  • Your contractions are monitored for how strong they are and how often they are coming.

  • Your physician will assess if your baby is in low in the birth canal.

  • A speculum examination will be performed, to look at your cervix for cervical dilation, bleeding or if your membranes are ruptured (broken bag of water).

  • A swab of your vaginal secretions will be obtained for fetal fibronectin (fFN). fFN is used to help predict if you are at risk of delivery prematurely.

  • A group B streptococcal culture will be performed if not done within the previous five weeks.

  • A urine culture will be done, since a bladder infection is associated with an increased risk of preterm birth.

  • An ultrasound will be performed to evaluate the cervix length, and estimate how big your baby is.

Maternity Leave

If you are employed during your pregnancy, at some point in time you will want to talk with your employer about maternity leave. Many women assume that maternity leave is a right they are guaranteed to as an employee; however there are many employers that are not required to provide any type of leave for pregnancy. It is important that you know your rights with respect to maternity leave prior to delivery of your baby.

Some companies or states provide medical leave or maternity disability for women who are pregnant. This type of leave may or may not provide wage compensation for a period of time between six and eight weeks after delivery. New York, Rhode Island, New Jersey, and Hawaii actually have state run disability plans which can provide up to 60 percent of your pay during the first few weeks after delivery. However, even these programs have a cap, usually up to $600 per week. In California women enjoy a state run disability plan and also a state funded family leave plan.

Most companies don't provide paid maternity leave, in part because they aren't required to. Though some women will be eligible for unpaid leaves of absence during their pregnancy, others don't qualify because they haven't been on the job long enough or in some cases because the company they work for is too small to qualify for maternity leave programs under federal law.

It is important that you know your rights concerning maternity leave so you can discuss your options with your employer.

Typically, maternity leave falls into the category of disability leave, and for employers offering disability leave; this is usually a period of time up to six weeks for a vaginal delivery or eight weeks for a cesarean delivery that you are able to take off from work while your body recovers from delivery. Take note though, if you work for a very small company, such as a company with 10 employees or less, you may not be entitled to any type of disability leave. Be sure to check with your company's policies regarding maternity and disability leave now if you haven't already.

Some women will qualify for Family Medical Leave. The Family and Medical Leave Act or FMLA grants parents (including partners) 12 weeks of unpaid time off after the birth of a baby. The 12 weeks you take for your baby's birth can begin prior to actual delivery.

FMLA covers any employees, men and women who have worked at their current job for at least 12 months and 1,250 hours. You also must be employed by a company that employs a minimum of 50 employees within a 75 mile radius in order to qualify. If your company is smaller than this or you have not been on the job at least 1 year, then you will not qualify for this protection.

The FMLA leave is advantageous because it enables you to take this time off work to care for your newborn baby, and allows you to return to the same job you left or an equivalent job if your job is no longer available.

You should know that your employer can require you to use up your vacation and sick leave as part of the 12 weeks that you take off via FMLA.

Baby Section

Growth and Development of Baby

What a big baby you have at 27 weeks pregnant! Your little one now weighs just less than two pounds, and he or she is around 14.4 inches long.

Finally! Your baby's eyes open this week. Your baby's eyes have been fused shut since 9 weeks of gestation. The eyes have developed to the point where they can open and your baby can see! Although the eyes are open, they won't respond to light in a coordinated way just yet.

The retina, the light sensitive portion of the eye, typically starts maturing around this week. The layers that form in the retina will allow your baby's eyes to receive light and transmit the information it is receiving to the brain to form images. This basic process is referred to as "sight".

At this week of your pregnancy, your little one's reproductive organs are now in their proper places. If you are carrying a girl baby, her ovaries now contain all of the egg-producing follicles that they will ever make in her lifetime.

In a majority of boy babies, their testes have descended into the scrotum. But in a few boy babies, their testes will stay in their pelvic cavity until after they are born.

Now, your big baby is taking up a lot of space in the womb, and he or she now has less amniotic fluid around him or her. Because of this, you will feel his kicks and movements stronger than you did in earlier weeks of your pregnancy.

Your baby's coiling umbilical cord is around the same length as your baby. The umbilical cord grows as your little one grows throughout the remainder of your pregnancy. (next week)


Doctor's Corner

Pregnancy Week by Week - Women's Healthcare Topics