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

33 Weeks Pregnant

In This Article


Pregnant Belly Changes

Your uterus now measures roughly 5 inches above your belly button. You may have gained up to 28 pounds or more by this point in your pregnancy. Many women will gain weight more rapidly in the third trimester due to the rapid growth in their baby. Most babies start gaining anywhere from five to nine ounces every week from now on until delivery.

You are probably finding yourself more and more excited at the prospect of meeting your little baby for the first time. You are more than two-thirds of the way there by this point in time. You should consider pre-registering at your hospital if this is allowed. This will help speed the admissions process once you are in labor. The last thing you will have on your mind as you approach delivery is filling out lots of paperwork!

In the next couple of weeks, as you and your partner gear up for your baby's birth, you may experience a few false alarms and false runs to the hospital. This is especially true if this is your first pregnancy. False labor pains, also called Braxton-Hicks contractions, can be difficult to tell apart for first-time moms. They are commonly felt in the third trimester, as your body gears up for labor and delivery.

Even if you have familiarized yourself with the signs of Braxton-Hicks contractions, these false labor pains can still confuse you. In the weeks before delivery, these contractions can become more frequent and seem relatively close together. They may even feel painful. However, unlike the real onset of labor, Braxton-Hicks contractions will cause your cervix to dilate only a little.

If you are concerned about any contractions that you are feeling, don't hesitate to contact your doctor or midwife. In some cases, what you think might be Braxton-Hicks contractions may be true labor. Not every woman experiences false labor.

33 week pregnant belly

Pregnancy Symptoms

Fatigue
At 33 weeks pregnant, it's probably a struggle to get anything done. Fatigue is probably hitting you hard. Carrying around the weight of a growing baby can really take its toll on your energy levels. Try to get as much rest as you can in this final trimester.

Swelling (edema) is common pregnancy symptom now. You might feel like your ankles and feet are never going back to the same size. Remember to elevate your feet whenever you can. This can help minimize your swelling. Many women start experiencing mild swelling or edema. This pattern often remains as you continue your pregnancy. Some women find that swelling is worse during warm weather or in hot climates. If you are experiencing your third trimester in the middle of summer more kudos to you! You are probably very warm and quite bloated. Just be sure to drink plenty of water to keep your body as hydrated as possible. This will help with swelling and improve your comfort.

Carpal tunnel syndrome can also be problematic now. Some women begin experiencing numbness or tingling in their fingers and wrists at this time. This often results from a condition referred to as carpal tunnel syndrome. You may find the tissues supporting your wrists and hands also swell, pinching the nerves running through your wrist. This is often more noticeable for women who work in a job that requires frequent typing. If this is you ask your healthcare provider if wearing a brace will help relieve some of the discomfort you are experiencing in your wrists and hands. Taking frequent rest breaks should help relieve some of the discomfort and swelling you are experiencing.

Frequent urination is quite annoying now. Your uterus is adding pressure to your bladder and this makes you feel like you have to urinate all the time. Unfortunately, there's not much you can do to prevent this pregnancy symptom. Just keep in mind that it'll go away after giving birth.


Weight Gain

You may have gained up to 26 to 27 pounds by 33 weeks pregnant, though some women will have gained more. During this point in pregnancy, many women find that they gain weight faster than at any other time. This is partly due to the rapid growth your baby is experiencing and the extra water retention. Most babies will put on 5-9 ounces every week from this point out!


Pregnancy Health Section

Stages of Labor and Delivery

By 33 weeks of pregnancy most women, if not having a planned cesarean delivery, probably have started wondering a little bit about labor and delivery. Labor occurs in very distinct stages. Some doctors divide labor into three stages and include an 'early phase' whereas others divide labor into four stages, which considers the early stage as the first stage of labor. Below we have broken labor down into four distinct stages.

Learn about the 4 stages of labor.

Stage One of Pregnancy
Stage One or Latent Phase
The initial phase of labor is termed the latent phase or stage one. It begins when you feel regular contractions. During stage one of labor; your cervix will slowly start dilating (opening) and effacing (thinning). False labor and stage one of labor initially share similar characteristics. However, the contractions associated with latent labor become stronger, more regular, and more frequent over time; whereas the Braxton-Hicks contractions associated with false labor diminish in frequency and intensity.

During stage one; you may notice what is called a “bloody show”. This is a mucous discharge that is tinged with blood, and it is a perfectly common occurrence during early labor. Other women will lose their mucous plug during this time. Some women consider loss of the mucous plug a sure sign that labor has begun, but a woman can actually start losing her mucous plug weeks before delivery. The bloody show is a much better predictor of imminent labor than loss of the mucous plug.

The latent phase or stage one of labor is often the longest. Generally during this time, the cervix will dilate up to 2 centimeters.

Stage Two of Pregnancy Stage Two or Active Phase
During stage two, you enter what is referred to as the active phase of labor. This is where all the fun begins. During this time, your body will be preparing aggressively to deliver your baby. Typically, you will start experiencing contractions that become more frequent, lasting longer, and stronger. This stage of labor is associated with a faster rate of cervical dilatation and usually begins when you are 2 to 4 cm dilated. By this point in time, you should call your doctor and head to the hospital.

During the active phase of labor you will want to concentrate on your breathing and relaxation techniques. You may find your contractions get strong enough that you are unable to talk through them. If you have taken any prenatal classes, you will find the techniques offered come in handy.

Many women opt for pain medication during the second stage of labor. At this point, medication is not likely to slow or contractions down.

After you have been in active labor for some time, your body will enter the “transition period”. During this time contractions become strong and typically come every two to three minutes. Most women will find their contractions last a minute or more. During this phase, the cervix will dilate from 8 to 10 centimeters.

The transition period can take anywhere from a few hours to a few minutes. Typically this is the most painful part of labor. If you don't have any pain relief, you may feel nauseous and dizzy during this part of labor.

Stage Three of Pregnancy Stage Three or Time to Push
Once your cervix is fully dilated, you will be ready to push and give birth to your baby. Stage three is the period of time when pushing begins. Most first time moms will push for an hour or more, though it isn't uncommon to only push for 20 minutes.

Many women find this stage of labor exhausting and exciting at the same time. Every push helps your baby through the birth canal. For some women, the baby will descend rapidly with a few pushes, whereas others it may require pushing for an hour or more.

Your baby's head will advance down the birth canal until the head becomes visible. This is referred to as “crowning”. At this point, usually everyone starts sharing tears of joy, as your baby is about to make his appearance in the world. Your doctor may note that your baby has a full head of hair, or may comment that your little one is as completely bald. Right after your baby's head is delivered, your doctor will suction the baby's mouth and nose. Typically with the next contraction, your baby's shoulders and body will be delivered.

Stage Four of Pregnancy Stage Four or Delivery of the After Birth
Believe it or not, you are still technically in labor after your baby is born. After your baby is born, your uterus will continue to contract to help separate the placenta from the wall of the uterus. Once this happens, you may have to gently push to help deliver the placenta. Typically, these mild contractions occur a few minutes after delivery. For most women, the entire process takes less than 15 minutes. Most women don't even pay attention to this stage of delivery because they are consumed with the sight of their beautiful newborn baby.

There you have it, all the steps of labor easily outlined. Now you can start thinking about your big day, just a few short weeks away!


Preterm Labor

At 33 weeks pregnant, you are probably thinking about your baby's delivery. If you haven't already, you need to start preparing to go to the hospital at any moment. Even though your due date is 7 weeks away, you want to be prepared for any pregnancy complications that may occur, such as premature labor.

When you’re having preterm labor, it means you’re having regular contractions beginning before pregnancy week 37. These contractions will result in changes of the cervix including dilation. This is when the cervix opens allowing the fetus to go into the birth canal. Other changes include effacement. This is when your cervix thins out prior to birth.

Preterm labor, contractions beginning before pregnancy week 37

Preterm birth is when you deliver your child between pregnancy weeks 20-37.

Preterm birth is concerning for doctors because babies born too early may not have fully developed yet. This could lead to some serious health issues including cerebral palsy, which may be a lifelong condition. Other health issues including learning disabilities, which may come about either later in childhood or even as an adult.

Babies born before pregnancy week 34 are most at risk of having health problems, but babies born between weeks 34-37 also have some risk.

Preterm birth risk factors

  • A short cervix

  • Previous preterm births

  • Short time between pregnancies

  • Pregnancy complications including vaginal bleeding and pregnancies with multiples

  • Prior surgeries on the cervix or uterus

  • Smoking cigarettes during pregnancy

  • Substance abuse during pregnancy

  • Low pre-pregnancy weight

Preventing preterm birth

If you’ve already had a preterm birth before and you want to have another child, you’ll want to go in for a preconception care checkup before becoming pregnant. Once you are pregnant, you want to start with prenatal care right away. You may need to see a doctor with experience in high-risk pregnancies. If you have risk factors, you may also need certain medications or treatments for helping to prevent a preterm birth. Treatments are based on risk factors and individual situations.

Symptoms of preterm labor

You’ll want to call your doctor immediately if you have any of these symptoms of preterm labor:

  • Changes in vaginal discharge (bloody, mucus or watery)

  • Vaginal discharge increases

  • Continuous dull, low backache

  • Abdominal pressure that’s low or pelvic

  • Mild case of abdominal cramps, may include diarrhea

  • Your water breaks

  • Frequent or regular contractions, may be painless

Diagnosing preterm labor

Preterm labor is only diagnosed when the cervix starts changing. Your doctor may want a pelvic exam to see if your cervix is changing. You may actually need several exams over a period of several hours to tell. Your doctor will also be monitoring your contractions.

Your doctor may want to do some tests to see if you need to have specialized care or need to go to the hospital immediately. A transvaginal ultrasound exam can measure the length of your cervix. Doctors may also measure the fetal fibronectin, a protein found in vaginal discharge. This protein is linked to preterm birth.

Does preterm labor = preterm birth?

It’s not easy for doctors to know whether women having preterm labor will also have a preterm birth. About 10% of pregnant women having preterm labor actually deliver over the next few days. With about 30% of these women, the preterm labor simply stops.

When preterm labor continues

If your preterm labor doesn’t let up, the next step is based on your baby’s health, and your health. When there’s a possibility your baby will do better with delaying delivery, your doctor may give you certain medications. These could include magnesium sulfate, tocolytics and corticosteroids.

  • Magnesium sulfate - You may receive this medication if you haven’t reached pregnancy week 32, if you’re at risk of delivering over the next 24 hours, or if you’re in preterm labor. This may reduce the risks of cerebral palsy that early preterm birth includes.

  • Tocolytics - These drugs may delay delivery for only up to 48 hours. This sometimes gives time for you to take magnesium sulfate or corticosteroids, or time for you to be sent on to a hospital offering specialized preterm baby care. Magnesium sulfate may also be used as a type of tocolytic drug.

  • Corticosteroids - These drugs cross the placenta and help speed up your baby’s lung development, as well as digestive organs and brain. They help the most between pregnancy weeks 24-32.

When labor doesn’t stop

If your labor doesn’t stop, and you’re headed towards an early delivery, a team of doctors will usually be involved. This may include a neonatologist. This type of doctor specializes in treating newborn problems. The type of care your baby will need depends on how early your child is born. High-level neonatal intensive care units, also called NICUs, specialize in preterm infant care.


“My Water Just Broke, But I’m Having No Contractions”

Between 5 and 10% of all pregnancies may involve rupture of fetal membranes before the onset of contractions. It is noteworthy to mention that this condition occurs in no less than 60% of women who are already at term. When your water has broken and the contractions have not started, you are most likely diagnosed with premature rupture of membranes or PROM by your physician.

My Water Just Broke

PROM occurs when the sac that cushions and protects your baby breaks, causing the fluid within the sac to leak out through your cervix and birth canal

What is premature rupture of membranes?

An expecting mother who has manifested signs of rupture of membranes before the start of labor, but at term (greater than 37 weeks), is diagnosed with premature rupture of membranes or PROM. Do not confuse PROM with PPROM or preterm premature rupture of membranes. PPROM is characterized by rupture of membranes before 37 weeks’ gestation.

What are the possible causes of PROM?

The cause of premature rupture of membrane is multifactorial. One theory is conditions that lead to over distention of the uterus can cause PROM. Some of the conditions implicated include multiple gestations and excessive volume of amniotic fluid. Rupture of membranes without contractions at term has also been associated with cigarette smoking.

Different research groups suggested that membranes that rupture before labor may have different mechanical and chemical properties. One group found that women who had PROM had thinner and less elastic membranes at the site of break when compared to the general population. Another group found that collagen synthesis was also lower in membranes that rupture prematurely. Collagen is a fibrous tissue found in ligaments and tendons. Chorion, the outer membrane of the amniotic sac, is also made up collagen.

What are the signs of PROM at term?

The characteristic sign of premature rupture of membranes at term is the leaking of amniotic fluid without the occurrence of uterine contractions. A mother with PROM will most likely note either a large gush of fluid that wets their sheets or undergarments or a slow trickle of fluid that constantly moisten their sanitary pads. Diagnosis of rupture of membrane is established by inserting a speculum into the birth canal for inspection of the cervix and vaginal cavity. Pooling of amniotic fluid in the vagina is considered as the most reliable test to verify the diagnosis.

Vaginal discharge, vaginal bleeding, and a sense of pressure in the pelvic area are the other signs of PROM at term.

If the diagnosis is established, what’s next?

After the diagnosis of premature rupture of membrane is made, the next step is to determine whether to induce labor or to wait for you to enter spontaneous labor. Research revealed that about 90% of women with PROM will go into spontaneous labor during the first 24 hours of rupture.

There seems to be a debate as to what to do when PROM takes place. Some physicians suggest that labor should start within 24 hours as the risk of intrauterine infection exceeds the risk of artificial induction of labor. Others believe that the risk for intrauterine infection is low for the next 72 hours and waiting for spontaneous labor to start within 72 hours is fine. The thinking behind waiting is to avoid risks associated with artificial induction of labor, such as fetal distress, increased risk for infection, uterine rupture, and increased risk for a cesarean delivery.

It noteworthy to mention that available evidence suggests that induction of labor decreases the risk of infection, without increasing the risk for a cesarean delivery. Moreover, findings reveal that the risk for infection increases from 10% to 40% after 24 hours of PROM.

The succeeding sections discuss the events you should expect during labor induction and spontaneous delivery.

Induction of labor
If you decide to go through induced labor, your physician will first determine whether or not your cervix is favorable for labor and delivery. If the cervix is favorable (dilated), your physician will administer intravenous oxytocin to stimulate uterine contractions. Prophylactic antibiotics are also administered.

If your cervix is not favorable, your physician may have another approach. Misoprostol, an analogue of prostaglandin E1, is initially administered intravaginally to ripen the cervix. Ripening of cervix involves softening, thinning and dilating of the cervix. Oxytocin is also administered if you have not gone into active labor with Misoprostol. You will also receive prophylactic antibiotics to prevent infections that are usually caused by group B Streptococcus.

Spontaneous labor
Expectant management may also be considered. The risk for intrauterine infections at term with premature rupture of membrane is small, as long spontaneous labor occurs for the first 12 to 24 hours. Expectant management is usually not an option after the first 24 hours.

Sometimes, it will take a few hours for contractions to get going. As long as you and your physician have discussed about it and you and your baby are both doing well, waiting for a few hours can be considered. During the wait, you may try simple and effective methods that can stimulate uterine contractions. One of the most commonly used techniques is nipple stimulation. Stimulating your nipples either by hand or breast pump induces your posterior pituitary gland to release oxytocin, a hormone known to stimulate contractions. Walking around in your room or hall with a birth partner may also help

In most cases, the management will mainly depend on your desires. Before labor, it is strongly suggested to discuss your options with your physician, should PROM take place.

Baby Section

Your Baby at 33 Weeks of Pregnancy

At 33 weeks pregnant, your baby weighs over 4 pounds and may be as long as 17.2 inches! As your pregnancy week by week continues, your baby is spiraling toward his birth weight and length! By the time you give birth, your little one may be as heavy as 7 to 8 pounds and over 20 inches long.

Baby at 33 Weeks

Your baby's brain is busy maturing and increasing in size. Parts of the brain are starting to function, including the auditory cortex (the area of the brain that's responsible for making sense of sounds), visual cortex (the region of the brain that processes visual information), and Broca's area (the part of the brain that's involved in speech and language processing).

Your little bundle of joy's fingernails might reach the tip of his or her fingers. Fortunately, there is no danger of your child accidentally scratching his or her precious face – his or her nails are very soft, as a result of their constant immersion in amniotic fluid.

Your baby's bones continue to harden with the help of the calcium from your diet. (If you don't have sufficient calcium in your diet, your baby will rob this nutrient from the reservoir in your bones.

At this point in your pregnancy, your baby is swallowing almost a liter of amniotic fluid every day. Amniotic fluid provides your baby with proteins and nutrients, and it also aids in helping his gut development.

Your baby's nose is almost fully formed. The bridge has formed and your baby no longer has that "button nose" appearance. Your baby's face is rounding out, and your little one may actually be a bit chubby from here on out.

By 33 weeks pregnant, your baby is often making faces in the womb. He or she may be smiling, sticking out his or her tongue, and making the goofiest expressions.



Doctor's Corner

Pregnancy Week by Week - Women's Healthcare Topics

“Did My Water Break, or Did I Lose Control of My Bladder?”

It is not uncommon to hear pregnant women confusing their bag of water breaking with urine leaking, or vice-versa. You were probably told to wait until you feel pain if you are not sure, or that “you will know the difference” once it happens to you. However, most moms-to-be are more confused with these advises and are often left baffled once that special day arrives. Are you leaking urine or amniotic fluid? How will you know if your water breaks or have just lost control of your bladder? How will you know the difference?

PROM or Urine Loss

It is important to know when your bag of water breaks because it is a signal indicating that the day you’ve been preparing for nine months has finally come. Your bag of water may break spontaneously during labor or prior to the onset of labor. Between 8 and 10% of women experienced their bag of water breaking before labor. For certain women, the bag of water breaking is not easily noticeable.

Amniotic fluid

During your baby’s development inside your womb, he or she is protected and cushioned in a bag filled with clear to slightly yellowish fluid, called the amniotic fluid. In addition to its protective properties, the amniotic fluid maintains a steady temperature within uterine environment and facilitates the development of the lungs, the digestive system, and the musculoskeletal system of your baby. The amniotic fluid also prevents compression of the umbilical cord.

The bag that contains the amniotic fluid is called the amniotic sac. It consists of two membranes: chorion, the outer membrane, and amnion, the inner membrane. The chorion membrane contains collagen, a tough tissue that strengthens the chorion. Collagen is also found in ligaments and tendons. The amniotic membrane produces the amniotic fluid. It also forms a phospholipid that stimulates the synthesis of prostaglandins, which induce uterine contractions and trigger labor. Both membranes have no nerve supply, so when they rupture neither you nor baby experiences pain. The environment within the amniotic sac is sterile. It is locked in by the neck of the uterus.

What causes the breaking of the bag of water or rupture of membranes?

Towards the end of pregnancy, the amount of collagen in the membrane of the bag of water decreases. Collagen is what gives strength to the membrane. So, as the collagen decreases and your contractions intensify, the bag of water easily ruptures. As soon as the bag of water bursts, the amniotic fluid leaks out through the cervix and vagina.

Is it amniotic fluid or urine?

Late in pregnancy some women may report uncontrolled leaking of urine, which is a normal occurrence at this time. The increasing pressure of the baby on the your bladder causes discomfort and loss of urine. It is for this reason that urine is commonly mistaken as the amniotic fluid. So, how can you distinguish breaking of water from urine leaking?

When your water breaks, you will feel either a slow trickle or a large gush of fluid. A slow trickle indicates that the amniotic sac has a small leak in it. This type of flow may also suggest that your baby’s head is engaged into the pelvis. When the baby’s head sits closely over the cervix, it only allows small amounts of amniotic fluid to drain away. A big gush of fluid suggests that your baby’s head is not entirely engaged into the pelvis. This type of flow is more commonly reported by mothers who have given birth in the past, mothers carrying breech babies or women with twin pregnancies. Either way, the leakage signals the start of your labor.

Once the leakage starts, it is recommended to follow these steps:

  • Before going into panic, take a deep breath and gather your thoughts. Recall what has taken place before the leakage. Some women describe a distinct popping sensation before their water breaks.

  • The next step is to observe for the pattern of the flow. When the bag has finally broken, the leak can be steady and uncontrollable. If it is a slow trickle that stops, it is recommended to put on a sanitary pad or liner. Do not use tampons. If the pad is constantly moistened without coughing or straining, it is most likely that your water bag has broken. If it is a slow trickle, the flow causes constant wetness on your pad when you are in standing position. To be concise, suspect amniotic fluid leakage when the flow of the fluid is continuous.

  • Another way to determine whether you are leaking amniotic fluid or urine is to lie down on your back for around 30 minutes. This is method is suggested to women with a slow trickle or leak. If the fluid is amniotic fluid, it is expected to pool in the vagina when you are lying on your back. At the end of the recommended time, get up and check if the pad is wet or dry. A dry pad suggests that your water is likely unbroken; a wet pad most likely indicates leakage of the amniotic fluid.

  • Check for the color of fluid. The urine is normally pale yellow to deep amber in color, whereas the amniotic fluid is often colorless.

  • Smell the fluid. Does it smell anything like urine? The smell of the fluid can also help you know whether the fluid is urine or amniotic fluid. Amniotic fluid is somewhat odorless. If the fluid does not seem to be urine, it is likely that your water bag has broken.

What do you do if you think your bag of water broke?

If think your bag of water has broken or if you are uncertain on the type of leaked fluid, it is strongly recommended to call your health care provider immediately. Be prepared to give details of information for the following, abbreviated as CAST: C – color of the fluid, A – amount of leaked fluid, S – smell or odor of fluid, and T- time you first observed your water broke.

Your physician will give you simple instructions on how to test the fluid. He or she may also advise you to come to the office for further evaluation. If you are asked to go, it is time to get your bag containing the things that you may need before, during, and after labor. Your physician may order admission once rupture of membranes is established.



“Is it Normal to Have Amniotic Fluid That’s Not Clear?”

Aside from its valuable role in nourishing your baby’s growth and development inside the uterus, the amniotic fluid can also reveal essential details about the wellbeing of your baby. The color of your amniotic fluid is also a good indicator of fetal distress. Amniotic fluid is normally clear to slightly yellowish in color. Any deviation from its normal appearance signals the implementation of appropriate medical interventions. The succeeding sections will help you understand its role in fetal development, its diagnostic value and its ability to guide healthcare providers in managing you and your baby during labor and delivery.

What is amniotic fluid?

Amniotic fluid is a complex substance consisting of nutrients and growth factors that promote normal growth and development of your baby during pregnancy. The amniotic fluid is contained within the amniotic sac, which is made up of two membranes. The sac’s outer membrane is called the chorion. The main function of this membrane is to offer support to the sac that contains the amniotic fluid. The inner membrane is the amnion, which does not only support the amniotic fluid but also produces the fluid. This layer synthesizes a substance required to produce prostaglandins, which cause contractions of the uterine muscles and initiate labor.

The amniotic fluid is never stagnant. It is constantly formed and reabsorbed. Between the 20th and 25th weeks’ gestation, the volume of the amniotic fluid depends on factors involved with the circulation of the fluid. Inside the uterus, your baby continuously swallows the fluid. It is reabsorbed across your baby’s intestines to gain access into your baby’s bloodstream. The arteries in the umbilical cord exchange it across the placenta. At term the amniotic fluid measures between 800 and 1,200 mL. If the baby is unable to swallow the fluid, excessive amniotic fluid is detected, indicating a possible case of esophageal atresia or anencephaly of the baby. A disruption of the baby’s kidney function causes abnormally low volume of amniotic fluid.

The amniotic fluid facilitates proper development of bones by allowing your baby to move or float inside the uterus. It promotes lung and digestive tract development. The amniotic fluid prevents compression of the umbilical cord, maintaining fetal oxygenation. In addition, the fluid cushions the baby from movements and blows, and protects the baby from temperature changes.

What is a normal amniotic fluid?

The amniotic fluid measures from 800 to 1,200 mL at term. It has a pH of 7.0 to 7.5, which is neutral to slightly basic. Based on its pH, it is possible to distinguish it from urine, which is acidic. The pH of urine and vaginal secretions are acidic, and since the pH of amniotic fluid is basic a simple pH test will help differentiate between the two. Focusing on its appearance, the amniotic fluid is normally clear. It is colorless to pale yellow in color. The amniotic fluid is also odorless.

What is the significance of having an amniotic fluid that is not clear?

Any change in the color of the amniotic fluid can be an indicator of a potential problem. Some of the possible color alterations and their causes are the following:

Green amniotic fluid
Greenish amniotic fluid is one of the most obvious signs of passage of meconium into the amniotic fluid. Meconium is a sticky black to green substance that forms in your baby’s intestines starting 16 weeks’ gestation. It must be emphasized that a meconium-stained amniotic fluid is not always a sign of fetal distress but is strongly associated with its occurrence.

A green amniotic fluid indicates that the developing baby lost anal sphincter control, facilitating the passage of meconium into the amniotic fluid. The passage of meconium into the colorless and sterile fluid is initially caused by insufficient supply of oxygen to the fetus. Hypoxia induces a reflex that leads to increased activity of the bowel.

This finding may be associated with meconium aspiration syndrome, which can cause breathing problems for the newborn. In a breech delivery, meconium staining is expected as constant pressure applied to the buttocks leads to loss of sphincter control.

Brown particles in the amniotic fluid
This alteration also indicates the passage of meconium from the baby’s gastrointestinal tract to the amniotic fluid.

Dark to golden yellow amniotic fluid
This finding may indicate the presence of bilirubin, a yellow-orange chemical compound produced by the breakdown of old red blood cells. A dark to golden yellow amniotic fluid indicates either the presence of an old fecal material or development of hemolytic disease in the fetus. Hemolytic disease of the newborn, or erythroblastosis fetalis, occurs due to incompatibility of blood types between the mother and the baby. It frequently occurs when an Rh negative mother is carrying a baby who is Rh positive. The mother’s immune system treats the baby’s Rh positive red blood cells as foreign invaders, thereby developing maternal antibodies to destroy them.

Red to dark red amniotic fluid
Red amniotic fluid could be an indication of abruptio placenta, a condition where a normally placenta detaches from the uterus prematurely. This event is initiated by bleeding, which further leads to the formation and expansion of a hematoma behind the placenta. Blood may rupture through the membranes into the amniotic cavity or the products of hemoglobin breakdown diffuse across the membrane, causing dark red color of the amniotic fluid.

Pink amniotic fluid
Among all amniotic fluid color alterations, a pink amniotic fluid is the least severe. One of the indicators of labor is the passage of a bloody show, a stringy mucus vaginal discharge tinged with brown or pink blood. Throughout pregnancy, a thick mucus plug blocks or seals the opening of the cervix mainly to prevent bacteria from getting into the uterus. As the cervix dilates and effaces, the plug is dislodged. Minimal bleeding also occurs as cervical dilation and effacement involves rupture of blood vessels in the cervix. Because blood may dilute with the amniotic fluid, a pink amniotic fluid may be noted during labor.

Any color alteration of the amniotic fluid requires medical supervision. Before labor, it is recommended to discuss with your physician the options that you may consider should the color of amniotic fluid appears different from the normal.

(next week)


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