Pregnancy 38 weeks large fetus. Large fruit - good or not so

"The hero is born!" - hears a young mother whose newborn weighs more than 4 kilograms. Many parents are convinced that a large child is good: since it weighs a lot, it means that it is strong and healthy. Unfortunately, this widespread opinion is not always justified - the birth of a child with a large weight is sometimes associated with some problems.

First, let's define terms. If the weight of the child at birth is 4000-5000 g, the fetus is considered large. With a mass of 5000 g and above, the fetus is called giant. In this case, the height of the child is not taken into account, although, as a rule, the length of the body of such a "hero" also exceeds the average. So, if the "growth" of the fetus is 48-54 cm, then in large children this figure can be 54-56 cm. It should be noted that in last years there is an increase in the average weight, height and physical development newborns. This is probably due to the improvement of working conditions, life and nutrition of pregnant women. According to studies, the number of newborns with a birth weight of 4000 g or more is 5-10%. The birth of giant children is much less common.

Why is the baby so big?

Risk factors for the birth of large children are: heredity, diabetes, some other endocrine diseases, an increase in the duration of pregnancy, etc.

Increasing the duration of pregnancy can lead to the birth of large children. In this case, both the prolongation of physiological pregnancy and true overbearing are possible.

A prolonged pregnancy is considered to be a pregnancy that lasts longer than the physiological one by 10-14 days and ends with the birth of a functionally mature child without signs of overmaturity and "aging" of the placenta.

True overgestation is characterized by the birth of a child with signs of overgestation and pronounced changes in the placenta.

At the same time, the signs of overwearing are the lack of original lubrication, dryness, maceration (wrinkling) of the skin. The fetus's need for oxygen increases during pregnancy, and the placenta can no longer provide the fetus with the required amount of oxygen and other vital substances. There is also a decrease in the number amniotic fluid. With a significant overdose, an admixture of meconium (original feces) appears in the waters and their color becomes greenish or grayish.

pregnant women, patients with diabetes, it is necessary to be hospitalized in the department of pathology of pregnant women in the maternity hospital in the second half of pregnancy (not later). There they are examined in detail, and doctors decide on the date of their delivery. Artificial (not earlier) are carried out in cases where a woman carrying a large fetus has a progressive late, significant polyhydramnios, a decrease in blood sugar, since this raises the risk of intrauterine death of the fetus and birth trauma. During childbirth, insulin is needed. Insulin treatment continues postpartum period taking into account the level of sugar in urine and blood.

The reason for the large size of the fetus can be edematous form of hemolytic disease- a serious condition associated with the incompatibility of the blood of the mother and fetus according to the Rh factor. This disease occurs when a pregnant woman with Rh-negative blood carries a fetus whose red blood cells contain a positive Rh factor inherited from her father. As a result, the fetus develops anemia (decreased hemoglobin content in the blood), which is often accompanied by jaundice. In the most severe forms of hemolytic disease, anemia and jaundice are accompanied by general edema, fluid accumulation in the fetal cavities, enlargement of the liver and spleen. It should be noted that in a mother with Rh-negative blood and an Rh-positive fetus, pregnancy does not always proceed in this way. The situation is less favorable if the pregnancy with a Rh-positive fetus is repeated, a transfusion of Rh-positive blood was previously performed (even long before pregnancy), and also if the pregnant woman had the flu or other infectious diseases.

In order to prevent hemolytic disease in subsequent pregnancies, women with Rh-negative blood are immediately injected with anti-Rh immunoglobulin.

And yet, most often the cause of the large size of the baby is heredity. So, if the parents of the child had a large birth weight, it is likely that the baby will be large.

The reason for the formation of a large fetus can be malnutrition pregnant. So, an excess of carbohydrates (pasta, bakery, confectionery) in the diet contributes to fluid retention in the body, maternal obesity and the formation of an excessively large fetus. In this regard, most experts recommend limiting the use of products containing a large number of carbohydrates, especially in the second half of pregnancy, up to 300-400 g per day.

There is also a tendency to form a large fruit during the second and subsequent pregnancies. According to statistics, the second child is 20-30% larger than the first. It can be assumed that this is determined by several factors. One of them is psychological, that is, when carrying a second baby, the expectant mother is more calm, since she is no longer familiar with pregnancy and childbirth. Another reason may be that during the second pregnancy, the mother's body is already trained to carry the baby, blood circulation in the uteroplacental and fetal-placental vessels provides a greater supply of nutrients to the fetus than during the first pregnancy.

It is worth noting that with a genetically determined birth of a large fetus, the length of the baby's body is also quite large, so the size of the fetus is proportional. In this case, the dimensions of the baby's head, which play the main role during childbirth, are also quite large. If the cause of a large weight is any pathology (for example, hemolytic disease of the fetus), then the size of the fetus can be increased due to soft tissue edema. In post-term pregnancy, the bones of the fetus are less mobile and adapt worse to the birth canal of the mother, which creates additional difficulties and predisposes to injury to the mother and fetus during childbirth.

Diagnosis of a large fetus based on history and examination data. The doctor finds out what height and build the father of the child has, with what weight and height the children were born during her previous birth, whether the woman has endocrine disorders. On examination, the doctor pays attention to the increase in the volume of the abdomen (more than 100 cm), the size and density of the bones of the head, the large length of the fetus (more than 54 cm) and its estimated weight. If a large fetus is suspected, an ultrasound examination of a pregnant woman is mandatory, which allows, according to the fetometry of the fetus (head size, diameter and circumference of the abdomen, length of the femur and humerus), to calculate its estimated mass.

childbirth with a large fetus, they often proceed normally, but there is some likelihood of complications, which we will discuss in more detail.

Possible complications during childbirth

In the case when, after the full opening of the cervix, there is no advancement of the head, talk about the discrepancy between the size of the fetal head and the mother's pelvis- the so-called clinically narrow pelvis. In this case, the dimensions of the pelvis can be absolutely normal, but, nevertheless, it will present difficulties or obstacles for the course of these births. With anatomical narrowing of the pelvis (when all dimensions of the pelvis or at least one of them are shortened by 1.5-2 cm or more compared to normal ones), in combination with a large fetus, childbirth becomes impossible even with strong labor activity and good head configuration.

Untimely rupture of amniotic fluid during childbirth with a large fetus, it is associated with a high standing of the fetal head in the cavity of the small pelvis and the lack of differentiation of water into anterior and posterior (as occurs during normal physiological childbirth). There are situations when at the time of the outflow of water into the vagina, the umbilical cord or the handle of the fetus may fall out. In such cases, it is necessary to provide timely assistance to the woman in labor. Untimely discharge of amniotic fluid, as a rule, slows down the process of opening the cervix during childbirth. Contractions can be painful, and the first stage of labor (when the cervix dilates) can be protracted. With a long anhydrous period, there is a risk of infection of the fetus and uterus.

During childbirth with a large fetus, complications such as labor anomalies(primary and secondary weakness of tribal forces). Their cause can be infantilism - underdevelopment of the internal genital organs, difficult childbirth and postpartum diseases suffered in the past. At the same time, contractions from the very beginning of labor are usually weak, rare (primary weakness of labor activity). Sometimes the active labor activity that developed at the beginning of labor weakens later (secondary weakness of labor activity). At the same time, childbirth is delayed, the woman in labor gets tired. It may disrupt the functions of the nervous, cardiovascular and other systems, and the fetus has signs of hypoxia (lack of oxygen).

The greatest difficulties in childbirth with a large fetus can occur when. This is due to the fact that the head undergoes a significant change: the bones of the baby's skull move over each other, as if adapting to the shape of the woman's small pelvis. If there is a discrepancy between the size of the fetal head and the mother's pelvis, then the lower segment of the uterus undergoes significant overstretching and possible uterine rupture.

With prolonged standing of the fetal head in the pelvic cavity of a woman, compression of the soft tissues of the birth canal between the pelvic bones and the fetal head can occur. At the same time, in addition to the cervix and vagina, the urinary bladder and urethra are compressed in front and the rectum in the back. In soft tissues, blood circulation is disturbed, edema occurs. The mother may stop urinating. If tissue necrosis occurs, which is then rejected, then urogenital fistulas or rectovaginal fistula. Fistulas are passages between the bladder and vagina or rectum and vagina. This complication requires surgical intervention in the postpartum period.

With a prolonged period of exile, compression of the nerves is possible, with the subsequent occurrence in a woman paresis of leg muscles. This condition, accompanied by limping, is difficult to treat. If the passage of the head through the pelvis is difficult, damage to the pubic symphysis(articulation of the pubic bones). Women in childbirth have pain when moving their legs, gait is disturbed. With pressure on the area of ​​​​the pubic symphysis, pain occurs. The divergence of the pubic bones during childbirth is of varying severity. In severe cases, which is extremely rare, surgical treatment is performed. In other cases, you need bed rest, wearing postpartum bandage, the use of painkillers.

In cases of a slight discrepancy between the size of the fetal head and the mother's pelvis, expectant management is used during childbirth. This means that with normal labor activity and the absence of complications, childbirth occurs spontaneously, but if the signs of inconsistency with good labor activity and departed waters do not disappear within 3-4 hours, a caesarean section is performed.

If symptoms of a threat of uterine rupture occur, the woman in labor is immediately performed a caesarean section.

Even if childbirth goes through the natural birth canal and the head has already been born, complications often arise when removing the shoulder girdle of a large fetus. In this regard, the neonatologist conducts a thorough examination of the newborn for fractures of the clavicle or arm.

Prolonged labor and frequent anomalies of labor activity can cause a violation of the uteroplacental blood flow and fetal hypoxia. With excessive displacement of the bones of the fetal head and its sharp compression, hemorrhages can occur in the brain or under the periosteum of the parietal bones. As a result of hemorrhage of the second type, it is formed. In the first days after birth, it is covered by a birth tumor and becomes noticeable only after it disappears. In the absence of complications, cephalohematoma resolves on its own after 6-8 weeks and does not affect the child's condition. Hemorrhages in the brain, depending on their size and the affected area, can have various outcomes - from minor to severe.

It should be noted that in women in labor with a large fetus, the contractility of the uterus may be impaired, which may be due to bleeding after childbirth. It can also be caused by retention of parts of the placenta in the uterus, rupture of the soft tissues of the birth canal.

If it is assumed that the size of the fetus is large enough, then during childbirth, careful monitoring of the work of the fetal heart is carried out. The obstetrician-gynecologist conducting the birth listens every 15 minutes in the first stage of labor and after each attempt in the second stage of labor. Cardiac monitoring is indispensable in this case, in which a special sensor is attached to the abdomen of the woman in labor, which monitors the heart rate of the fetus. In cases of signs of fetal hypoxia, the necessary treatment is carried out.

The born child is carefully examined for hypoxia and birth injuries. The examination will help the doctor identify signs of hemolytic disease, diabetes, and other disorders.

It should be noted that the described complications during childbirth with a large fetus in many cases are absent or are not very pronounced. At good care and proper feeding, large children do not differ from their peers.

So, if the doctor has told you that your baby was born large, know that you will need especially careful medical supervision.

Olga Ovchinnikova
gynecologist, Central Customs Hospital

Pregnancy is a time of expectations, dreams of a beautiful and future baby. During pregnancy, there is a certain plan for observation by the doctor and certain number scheduled ultrasound examinations. And on one of the ultrasounds, any woman can hear the phrase "You are bearing a hero." This means that a large fetus is developing inside you.

There are certain norms for the weight and height of the baby at the time of birth. It is considered normal when a child with a height of 48 - 54 cm has a weight of up to 4,000 kg. If the baby weighs from 4 to 5 kg at the time of birth, then they talk about a large fetus during pregnancy. But it is strange that in this case they do not take into account the growth of children. After all, large kids are always taller than children, which, as they say, are normal. The growth of large babies is usually 54 - 56 cm.

According to statistics, today the number of large children is 5-10% of all pregnancies. Doctors believe that this is due to the improvement of working conditions, full and healthy eating and the living conditions of pregnant women.

There are also cases of the birth of giant babies: weight over 5 kg. But such cases are recorded much less frequently.

How to identify a large fruit?

Starting from the 12th week of pregnancy, the doctor at each examination listens to the baby's heartbeat, measures the circumference of the hips and abdomen of the pregnant woman, and the weight and pressure of the pregnant woman is also measured in the pre-medical office. All these measurements are not made in order to indicate to the woman how she has recovered and to offend her. All this is done in order to clearly draw a picture of the course of pregnancy and monitor the health of the baby and expectant mother.

Diagnosis of a large fetus during pregnancy is made not only on the basis of an examination of a woman. An experienced doctor always takes into account heredity and disease. The doctor should ask about the physique of the father, about the weight with which the future parents themselves were born. If, from all the data of the examination and interview, a suspicion of a large fetus is diagnosed, only then a referral for an ultrasound is issued. Only on the basis ultrasound you can calculate the estimated weight of the baby.

On such an unscheduled study, the size of the fetal head, the diameter and circumference of the abdomen, the length of the femur and humerus of the baby are determined. And based on these data, it becomes possible to calculate the estimated weight of the fetus.

Causes of a large fetus

There can be many reasons why you are carrying a hero. Some of them are associated only with heredity, some are a reflection of the mother's lifestyle or an echo of her state of health. Let us dwell in more detail on the reasons that the fetus is overweight during pregnancy.

1. Increase in duration of pregnancy. There are two terms that are associated with a long gestation period: the prolongation of a physiological pregnancy and the prolongation of a pregnancy. Prolongation is due to the fact that the timing of childbirth was incorrectly set. In this case, a healthy baby is born, but for 10-14 days late established by doctors. The health of the baby is determined by the absence of signs of overbearing and aging of the placenta. With a true prolongation of pregnancy, a baby is born with the following signs:

• wrinkling of the skin;
• greenish or grayish tint of amniotic fluid;
• lack of original lubrication; dryness.

2. A disease such as diabetes, can lead to a large fetus during pregnancy. A pregnant woman with diabetes mellitus should be examined more carefully than the others. Among such women, the statistics of the birth of large children is much higher.

Such pregnant women should be hospitalized no later than 32 weeks of pregnancy. In the hospital, they undergo a thorough examination, after which a decision is made on the timing of childbirth. If a patient with diabetes bears a large fetus, then the issue of artificial stimulation of labor is decided not earlier than 36 weeks. This decision is also made when the woman's health deteriorates (preeclampsia, decreased blood sugar,). Childbirth in this case takes place under the close supervision of a therapist. Insulin is administered during all births. Insulin treatment continues after delivery, depending on test results.

3. Hemolytic disease of the fetus- a serious reason for the development of a large fetus during pregnancy. This disease is caused by Rh-conflict mother and child. It occurs in Rh-negative women when the baby inherits an Rh-positive father. As a result of this disease, the baby not only has a decrease in hemoglobin levels and jaundice appears, but also overweight due to the accumulation of fluid in the body cavities (swelling appears), the spleen and liver increase.

4. Heredity in the development of a large fetus plays an important role. If the mother or father of the baby is tall and large in this moment, then there is a high probability that the child will be large. Also today, small parents could be born large. Then the baby can inherit this very fact and will also be a hero.

5. There is also a tendency for large fetuses to develop in subsequent pregnancies. According to statistics, the second and subsequent children are born with a weight of 30% more than their older brothers and sisters. This is primarily due to the psychological factor (during the second pregnancy, the mother no longer experiences such great stress and fear). The second reason is the readiness and training of the woman's body to bear a baby (now the metabolism between mother and baby is improving due to better blood circulation).

6. Nutrition of a pregnant woman can also affect the excess size of the baby. A large amount of food containing carbohydrates (bakery, sweets) contributes to obesity of the mother and child. In this case, the baby's body begins to work like a mother's and gains excess weight. Already in the womb, obesity can develop.

Danger with a large fetus

The final stage of pregnancy - childbirth, is one of the most responsible and difficult moments of expecting a baby. Carrying a large child can cause certain difficulties in the process of delivery. These difficulties can affect both the health of the mother and the health of the newborn.

First of all, with a large fetus during pregnancy, there may be discrepancy between the size of the baby's head and the mother's pelvis . Even if the pelvis is not narrow, the head of a large baby may not pass through the birth canal. In this case, even a good, strong labor activity will not be able to provide natural delivery.

The head of a large fetus stands high in the pelvic cavity, this is the reason for the lack of distinction between the anterior and posterior amniotic fluid. This difference from normal physiological childbirth causes early effusion of amniotic fluid. If the fetus is large, then along with the discharge into the vagina, the umbilical cord or the baby's pen may fall out. In this case, an immediate surgical intervention is performed. Early outflow of water slows down the process of opening the uterus, and the period of contractions makes it very painful. The fact that the baby is without water for a long time can cause infection of him and the uterus.

The development of a large fetus during pregnancy can cause labor disorders . Such a violation is characterized by good and strong activity in the first stage and a decrease in labor activity in the later stages of childbirth. As a result, the woman in labor gets tired and cannot push. Also, cases of violations of the activity of the nervous, cardiovascular system are not uncommon. A large fetus in this situation suffers from a lack of oxygen - hypoxia. Such a violation may be characterized by very weak contractions in the first stage of labor.

During attempts, when the baby's head takes the form of a woman's small pelvis, uterine rupture problem . This happens, again, due to the discrepancy between the size of the small pelvis and the head of a large fetus.

emergence urinary or rectovaginal fistulas not uncommon at birth of large children. This is due to the long standing of the baby's head in the pelvic area of ​​a woman. In this case, necrosis of the tissues of the bladder, rectum and urethra occurs. Dead tissue is then torn off, forming fistulas. The problem is solved only by surgical intervention after childbirth.

With a long period of childbirth, pinched nerve in leg , there is also a possibility of damage to the articulation of the pubic bones. This is reflected in the gait of a young mother, limping and pain appear when moving the foot. If the degree of nerve damage is high, then surgery is required to solve the problem. With a mild degree of paresis, bed rest and a bandage are recommended. At the discretion of the doctor, pain medication may be prescribed.

All of the above can occur even before the birth of the baby's head, which was considered large during pregnancy. But even when, it would seem, the most difficult thing is behind, problems can arise. After the birth of the head of a large fetus, difficulties may arise in removing the baby's shoulder girdle. If the child is large, then, first of all, the neonatologist pays attention to the condition of his clavicles and arms.

A mismatch between the mother's pelvis and the baby's head can cause hemorrhage in the brain in a child or cephalohematoma. If there are no complications, then after 6-8 weeks the hematoma subsides without affecting the health of the child. Hemorrhage can also remain without consequences for the development and health of the baby. It all depends on its size and zone of outpouring.

We must not forget that a woman who gave birth to a large baby may have inadequate contraction of the uterus . As a result, bleeding may occur after the baby is born. The causes of bleeding are both retained placenta in the uterus, and ruptures of the tissues of the genital tract.

What to do?

If, after another examination by a doctor, you were told that you have a large fetus, you should not panic. A large fetus during pregnancy is the need for more careful monitoring in the future and during childbirth. Having learned that the baby is large, the doctor, first of all, will try to find out the reason.

If the cause is any pathology of the development of the fetus or the health of the woman, treatment in a hospital will be prescribed. In this case, in most situations, the woman is under observation until the very birth, as there is a need for constant teaching of drug treatment.

If the cause of a large fetus is heredity or mommy's overeating, then a diet is prescribed. According to the diet, the mother should receive only wholesome food that will not contribute to weight gain.

It is also not worth being afraid of childbirth with the development of a large fetus. The only thing you need to do in advance is to talk to your doctor about the progress of your labor. In some cases, a caesarean section is immediately prescribed, in others they take expectant tactics.

Indicators for caesarean section already in the process of labor is the presence of signs of discrepancy between the head of the child and the pelvis of the mother within 4 hours.

That is, if the birth is scheduled for natural, then subject to the spontaneous course of labor and the departed waters, the doctor can decide on the operation if the life of the mother or child is threatened.

38 weeks of pregnancy is exactly 36 weeks of embryonic development of the crumbs. That is how much time it grows and develops inside the mother's womb. During this time, the baby has come a long way, completely repeating the entire evolution of mankind.

What he became and what is happening to him now, we will tell in this material.

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Weight and height

The fetus at the 38th week of pregnancy is completely ready for independent life outside the mother's belly. R odes can happen at any moment, and you should not be afraid of this - they will not be considered premature, because the baby is full-term and matured.

What is his height and weight now, it is difficult to answer. The time of embryonic development has passed, when all the crumbs grew at about the same speed.

Now the size of the baby is purely individual and depends on two components: heredity and health.

If the mother and father of the crumbs have solid forms, then the crumbs will not be small. If the parents are petite, then the baby will be small. The weight of the fetus while it is in the mother's womb is difficult to determine, so the concept of "estimated weight" is used.

Assumes his program embedded in the ultrasound scanner. According to the size of individual parts of the child's body, she first gives a conclusion about the possible weight of his body. It should be taken into account that the error in this case is about 14% of the child's body weight up or down.

On average, babies at 38 obstetric weeks weigh more than 3 kilograms (3200-3600 gr). Height is 48-50cm. A large fetus at this time already weighs about 4 kilograms, and its growth can be 55-56 centimeters. If the pregnancy is difficult - with preeclampsia, Rhesus conflict, intrauterine growth retardation, the weight may be small for a given period - within 2600-2800 gr.

Fetometry by ultrasound - norms

Ultrasound at this time is done to clarify the expected date of birth, to assess the degree of maturity of the baby's lungs and to study the characteristics of the placenta, which "works" at the limit of its capabilities - its inevitable aging has begun.

Fetometric indicators of the baby at this time are as follows:

• biparental head size(BPR) on average - 93-94 mm;
• fronto-occipital size(LZR) - 110-118 mm;
• femur length- 74-75 mm;
• leg bone length- 64-65 mm;
• tummy circumference- 330-336 mm;
• Head circumference- 330-333 mm
• chest diameter- 101 mm.

There are no strict norms at 37-38 weeks, because the physique is also an individual trait.

In some babies, the length of the thigh will be more than normal just because the baby has inherited long legs, and the other will have a smaller head, because everyone in the family has small, neat heads, so the data presented above is just an average.

Appearance

At 38 weeks pregnant, the baby looks like a fully formed little person. This is how mom will see him very soon, nothing else will change in his appearance.

The skin of the crumbs has acquired a delicate pink shade, they are no longer red and wrinkled. The wrinkles were smoothed out due to the fact that during the third trimester the baby accumulated a large amount of subcutaneous fat, for the same reason the skin color also changed.

Blood vessels with the appearance of a "fat layer" have become further from the surface of the skin, the redness and network of blood vessels are now almost invisible.

Some palms and heels remained wrinkled, but they will remain so after childbirth for at least another 1-2 months. Until recently, the entire body of the child and his face were covered with a thick white primordial grease. She protected her parchment-thin skin from negative impact different factors. Now there is no lubrication. She remained in small quantities only where there is a possibility of friction - in the folds of the skin in the groin, under the knees, in the fold of the upper limbs and quite a bit in the neck crease.

98% of boys had their testicles descended into the scrotum by 38 weeks., this fact can be certified by the doctor of ultrasound diagnostics. For the rest, the testicles may descend before 40 weeks or after childbirth.

In girls at 38 weeks of gestation, the small labia are covered with large, this is the main sign of the correct development of the external genitalia in female fetuses.

Both the labia and the scrotum can be slightly enlarged, because right now the mother's body produces a large amount of estrogens - hormones that help the mother's body prepare for childbirth. A side effect of these hormones is a slight swelling of the genitals and mammary glands of the fetus.

The amount of hair on the head can be different. There are kids with solid and funny hair, and there are bald crumbs, this is a genetic feature. But all the babies this week have quite long and sharp fingernails, and they continue to grow.

Lanugo - a small fluff that covered the entire body of the baby, completely disappears at 38 weeks. The skin becomes smooth and tender.

The facial skeleton and facial muscles are fully formed. On a three-dimensional ultrasound image, you can clearly see which parent the child looks like, and if you do a four-dimensional ultrasound, you can enjoy the variety of grimaces and facial movements that the baby now “owns” perfectly.

Development of internal organs

All organs of the baby are formed and are already working. The only exceptions are the lungs, which will begin to work immediately after birth. An important process is now being completed in them - the accumulation of a special substance of surfactant, which will enable the lungs to turn around normally at the first breath of the baby.

The cardiovascular system of the crumbs works smoothly - heart rate (HR) at this period averages 157 beats per minute(permissible fluctuations - from 146 to 168 beats per minute).

In boys, the heart beats a little slower than in girls, although this fact, confirmed by obstetricians with rich experience, is not recognized by official medicine. The heartbeat is well heard on ultrasound, CTG, and even at home using a conventional phonendoscope.

The digestive organs of the baby are coordinated with each other. He swallows amniotic fluid, the stomach digests them, burps the excess (this is how hiccups occur), the rest goes into the intestine, which has already accumulated and continues to accumulate the original black-green meconium stool. It is meconium that will leave the intestines after birth, thereby starting the work of the digestive organs in a new environment for the baby.

The kidneys, liver, pancreas of the child and other organs regularly perform their functions.

Nervous system

Nervous system so far imperfect. And so it will be for a long time after the birth. In the brain every day there are more and more neural connections, and this process will continue.

The baby moves quite "meaningfully", all his movements at the level of motor skills are controlled by the brain. Until a few months ago, most of the movements were chaotic. In the arsenal of the baby there are several dozen reflex movements necessary for a person, even such a small one, to survive.

The baby is fluent in sucking, swallowing and grasping reflexes. He feels a lot and subconsciously understands: this can explain the emotional response that babies show at 38 weeks of gestation.

They can experience fear, joy, they can worry and be nervous with their mother, if she is worried. They recognize native voices from a mass of other sounds.

sense organs

A child at 38 weeks of gestation, while not sleeping, is actively exploring the world that surrounds him in the womb. He opens and closes his eyes. Vision is formed, but its functions are still insufficient, to see in the normal sense of the word, the child will begin a few weeks after his birth.

Now he only distinguishes between blurry contours and light spots, distinguishes light from darkness well, and already knows exactly when it is day and when it is night outside of his mother's belly.

The baby's hearing works great. He listens to the voices of mom and dad, mother's heartbeat, intestinal motility, buzzing blood flow through the vessels. Extraneous sounds, especially sharp and sudden ones, can frighten the baby, for example, claps, calls, loud barking of a dog. In response to familiar, and therefore “safe” sounds in the understanding of the crumbs, the baby calms down, unfamiliar ones can cause him increased motor activity or fading in anticipation - this depends on the nature of the baby.

Baby at 38 weeks distinguishes taste well, taste buds work and give him all necessary information about the taste of amniotic fluid, which changes depending on the food that the mother eats.

The baby’s sense of touch is well developed, in the womb he studied a lot by touch, and after birth, tactile contact with his mother will be the best “soothing” for the baby for a long time to come.

perturbations

The number of normal movements at week 38 may decrease, because the baby is already so large that it occupies the entire uterine cavity, there is no room for maneuvers and movements. This does not mean that a woman should stop monitoring the number of movements. As before, you need to mark them within 12 hours. During this time, the mother must count at least 10 episodes of activity..

If it seems that the baby is moving a little, he has calmed down for more than 3-4 hours, it makes sense to inform the doctor about this. Active movements, especially at night, if they cause pain to a woman, if they are sharp, chaotic, can also be an unfavorable sign of possible fetal hypoxia due to aging of the placenta, due to entanglement with the umbilical cord.

If the baby moves a lot or, conversely, moves a little, you should do a CTG, an ultrasound scan and, together with the doctor, decide what to do next.

presentation

At this time, the vast majority of babies take the most suitable position for birth - the head. With it, the fetal head is already tightly pressed to the exit from the small pelvis, practically rests on it, this causes unusual sensations in the mother - she has a pull on her lower abdomen, there may be various “tingling” in the lower abdomen, often there is an urge to urinate.

If the baby strongly presses the head on the nerve endings, the woman may feel as if she is being “shocked”.

If the baby is in a breech presentation this week or is located across - in a transverse presentation, then there is practically no chance of him turning over to the head position due to the fact that there is very little space left in the uterus for movements, and the amount of amniotic fluid has significantly decreased .

At 38 weeks, an ultrasound is done, and, if the abnormal location is confirmed, a planned caesarean section is scheduled, which is carried out at 38-39 weeks, or a week later. In addition to the risk of injury during childbirth, if the child lies incorrectly, the presentation does not create any other threat to the baby.

Possible problems

What happens to the baby at the 38th week of pregnancy can be told by cardiotocography, which is sometimes prescribed before childbirth at this particular time. If, according to the results of the study, the baby has tachycardia or bradycardia, if he often hiccups, hypoxia is not excluded, the woman will be offered labor induction or caesarean section as soon as possible.

If the expectant mother is already in the hospital, CTG will be done there, if she is at home, the procedure is carried out in a consultation at the place of residence.

At this time, independent childbirth can begin. In front of them, babies usually calm down and reduce their activity in a few days. Childbirth can begin with contractions, with leakage or discharge of amniotic fluid, with the exit of the mucous plug from the cervical canal.

With the appearance of atypical discharge at this time, increasing pain in the lower back in the lower abdomen, the expectant mother needs to call an ambulance or go to the hospital on your own. According to statistics, about 35% of babies are not born on the due date (the estimated date of birth indicated on the exchange card), namely at 38 weeks of gestation. This is completely normal.

You can read more about pregnancy at week 38 from the following video.

• What's happening
• Fetal development
• discharge and pain

There is an opinion among the population that big weight the fetus speaks of health and strength, but only mothers who have given birth to "heroes" and doctors know what difficulties they have to face during childbirth and after the birth of a child. If you believe the statistics, then the birth of a large child is noted in 5 - 10% of all births.

Definition of concepts

A large fetus or macrosomia is said to be when its fetometric indicators of intrauterine development significantly exceed the established norm for a particular gestational age, or the weight of a newborn is 4 kg or more. In addition to the weight of the child, his height is also taken into account, for example, in a normal baby, growth is in the range of 48 - 54 cm, while the length of a fetus with a large weight is 54 - 56 cm, and in some cases reaches 70 cm.

If the weight of the child at birth is 5 kg or more, then they speak of a giant fetus. The birth of giant children is less common than large ones, and has a ratio of 1/3000 births.

Causes

Why a child is born large is explained by many reasons, which can be due to both the characteristics of the woman's body and the individual characteristics of the baby developing in the uterus. These factors include:

genetic predisposition

It is noted that heredity also plays a role in the birth of a large child. Physically developed and tall parents have a greater opportunity to produce a large baby.

Increasing the duration of pregnancy

Normally, pregnancy lasts 38 - 41 weeks (see). If the gestational age exceeds the upper limit of the norm, they talk about over-pregnancy, which can be true and false. With true overwearing, a child is born with obvious signs of overwearing: dry, without original lubrication of the skin, its wrinkling, waters have a greenish or grayish tint, and their number is reduced. Such phenomena are explained by the aging of the placenta, the formation of multiple calcifications in it, and a decrease in its functions. The lack of oxygen and nutrients leads to the development of placental insufficiency, hypoxia and even fetal hypotrophy.

Diabetes in a woman

The birth of a large baby (or on ultrasound more than the gestational age) may be due to the presence of diabetes in the mother or its development during gestation (gestational diabetes). Children are born with a number of characteristic signs, which is called diabetic fetopathy. The large weight of the fetus is the result of hormonal storms and constant jumps in the level of glucose in the woman's blood. A characteristic sign of diabetic fetopathy is excessive weight gain in the baby after 20 weeks of pregnancy against the background of developing polyhydramnios. Accordingly, the child, although born large, is initially unhealthy. Pregnant women with diabetes are hospitalized no later than 32 weeks, examined and decide on the timing and methods of delivery.

Rh-conflict pregnancy

One of the reasons that determine the size of the fetus over the term is. This complication of gestation occurs when a child with a positive Rh factor is born by a woman who has a negative Rh factor. As a result, the unborn child develops a hemolytic disease, which is characterized by anemia and jaundice, and in extremely severe forms, swelling joins them, which is called the edematous form of hemolytic disease. At the same time, in the cavities of the fetus (stomach, chest) fluid accumulates, and the liver and spleen increase significantly in size. Massive edema and hepatosplenomegaly determine the large weight of the child.

Features of the placenta

Structural and functional features placenta (see also). Often at the birth of a child with a large body weight, the placenta is noted large sizes and thickness (5 or more cm). A thick and massive placenta promotes an intensive exchange of nutrients and microelements, which accelerates the development of the fetus. In addition to an increase in the volume of circulating blood and intensive blood supply to the child, there are bursts of placental hormones, which indirectly affect the metabolism in the mother's body and enhance the growth and development of the baby.

Subsequent pregnancies ending in childbirth

A directly proportional relationship was noted between the number of births and the body weight of children born. After the second, third, and so on, a large fetus is formed, which is about 30% larger than the size and weight of the firstborn. Doctors explain this fact in two ways.

• Firstly, the psychological factor matters, a woman, bearing a second / third child, is familiar with the processes of pregnancy and childbirth, is more balanced and calm.
• Secondly, the large size of the baby during subsequent pregnancies is due the best conditions intrauterine nutrition due to the developed circulatory network in the uterine wall.
• Also, the conditions for intrauterine growth and development of the second child are much better due to the greater extensibility of the uterus and slight resistance of the abdominal muscles.

The nature of the nutrition of a pregnant woman

An important role in the increase in the weight of the child is played by the nutrition and lifestyle of the woman, especially after the 20th week of pregnancy (see). Hypodynamia, a growing belly, a passion for high-calorie foods (consumption of muffins, sweets, pasta) leads not only to the accumulation of fatty tissue in the expectant mother, but also provokes macrosomia in the fetus (see).

Obesity

Excessive weight of the expectant mother also plays a role. This is due not only to poor nutrition of the pregnant woman, but also to impaired lipid metabolism in her body, which provokes a violation of the metabolism of proteins, fats and carbohydrates in the fetus, intrauterine damage to the liver and pancreas, and activation of compensatory reactions in the placenta. All these factors contribute to the rapid growth and weight gain of the fetus. In the case of obesity of the 1st degree, a large fetus is born in 28% of pregnant women, with the 2nd degree, the probability of a large child increases to 32%, and with the 3rd degree, up to 35%.

Taking medications

Uncontrolled consumption of certain drugs by a pregnant woman, which improve uteroplacental circulation and activate anabolic processes (for example, gestagens,) also contribute to weight gain.

Other factors

The woman's age (under 20 or over 34), presence of inflammatory processes organs of the reproductive system can also affect the size.

Large fruit: signs and diagnosis

If a woman has a large belly during pregnancy, this is not necessarily evidence of a large child. Should be excluded multiple pregnancy and (many pregnant women neglect the passage of ultrasound in such an important period of life).

By 38 weeks of pregnancy, and sometimes even earlier, the clinical manifestations of a large fetus are objective data obtained during a visit to an obstetrician. At each appearance in the antenatal clinic, a pregnant woman is measured body weight, an increase of 500 grams. weekly, against the background of absent edema and other signs of gestosis, makes the doctor suspect a large weight in the baby.

In the case of a large fetus during pregnancy, the signs are determined by the size of the woman's abdomen (circumference and height of the fundus of the uterus), evidence of this is the exceeding dimensions: The circumference of the abdomen is more than 100 cm, and the height of the fundus of the uterus is more than 40.

The estimated weight of the fetus is calculated by the formula: coolant is multiplied by VDM.

Since a baby with a greater weight takes up more space in utero, internal organs women are subjected to greater pressure and infringement and experience significant stress. As a result, the pregnant woman notes frequent urination, heartburn (reflux of gastric contents into the esophagus), constipation and shortness of breath. A large uterus presses on the inferior vena cava, which can provoke fainting in a horizontal position lying on your back. The load on the musculoskeletal system increases, which is manifested by pain in the legs, lower back, spine and ribs. Possible occurrence or worsening of the course of varicose veins of the legs. Also, there is a high probability of stretch marks on the abdomen and an increase in the tone of the uterus.

Ultrasound is of great importance in the diagnosis of a large fetus, with a thorough measurement of the fetal data of the fetus and the determination of its estimated weight. The circumference of the head and abdomen, the length of the femur and humerus are measured. A large head and a significant size of the abdomen, an increase in the liver and spleen, the identification of fluid in the body cavities indicates an edematous form of hemolytic disease.

The course of pregnancy

Pregnancy in women with a large fetus proceeds, as a rule, without complications. All the described complications (fainting, problems with the digestive tract and shortness of breath) develop by 38-40 weeks of pregnancy with a large fetus. There is a high probability of developing placental insufficiency and progressive hypoxia as a result of a discrepancy between the uteroplacental blood flow and the rapidly increasing weight of the child. Pregnancy features include:

• a thorough examination to exclude polyhydramnios and;
• exclude diabetes mellitus - conducting and consulting an endocrinologist;
• calculation according to ultrasound data and the size of the pregnant belly of the estimated weight of the fetus;
• physiotherapy;
• diet correction (exclude easily digestible carbohydrates and refractory fats);
• cancellation or restriction of taking drugs - anabolics.

The course of childbirth

“How to give birth if the fetus is large?” expectant mothers ask. The answer is not the course of childbirth, which, with large sizes, have their own characteristics. Spontaneous childbirth of a child of considerable size is often complicated by the following circumstances:

Clinically narrow pelvis

This complication develops when the fetus has big head and even with full disclosure (10 cm) of the uterine os, it does not advance, which is called a mismatch in the size of the head of the woman's pelvis. It is characteristic that the size of the maternal pelvis may be within the normal range, but still, childbirth is difficult even with good and strong contractions. If there is also an anatomical narrowing of the pelvis (the size of the pelvis is shortened by 1-1.5 cm or more), the question of a caesarean section is raised.

Untimely outpouring of waters

Early discharge of water (before the opening of the pharynx by 8 cm) is due to the high standing of the baby's head, so due to its large size it cannot press against the entrance to the small pelvis and move forward, and there is no separation of water into the anterior (fetal bladder) and posterior ones. Early outflow of water is dangerous by prolapse of the umbilical cord or small parts of the child (leg, handle). In addition, this complication slows down the process of opening the uterine os, which lengthens the 1st period of labor and exhausts the woman in labor. If the anhydrous interval continues for 12 hours or more, the risk of the uterus is also high. If the umbilical cord or part of the fetus falls out, immediate operative delivery is indicated.

Anomalies of tribal forces

Childbirth with a fetus of large size is often complicated by anomalies of labor activity. A protracted course of childbirth leads to a decrease in the intensity and frequency of contractions (weakness of the birth forces develops, both primary and secondary). The child begins to suffer, intrauterine hypoxia increases (at first it becomes more frequent - tachycardia, then it slows down - bradycardia), which is also an indication for caesarean section.

Threat of uterine rupture

The straining period of childbirth with a large child is also fraught with danger. In the process of passing the fetal head through the birth canal, it is configured, that is, it acquires a shape that is convenient for overcoming the planes of the small pelvis (the bones of the skull "layer" on top of each other). With a disproportionate size of the baby's head and the mother's pelvis, the lower uterine segment is overstretched, which threatens to rupture it.

Fistula formation

Due to the prolonged standing of the baby's head in the same plane of the pelvis soft tissues birth canal (cervix and vagina) are compressed, but in addition to them, bladder and the urethra in front and the anus in the back. This leads to impaired blood circulation in the tissues, ischemia, and then necrosis (necrosis). Necrotic tissues are shed after childbirth and genitourinary and/or rectovaginal fistulas are formed.

Rupture of the pubic joint

Difficult passage of the baby's head can damage the pubic articulation (rupture of the ligaments and divergence of the pubic bones), which often, especially in severe cases, requires surgical intervention after childbirth (see).

Shoulder dystocia

Childbirth with a fetus with a large weight can be complicated by difficult removal of the shoulders, which is typical for children with diabetic fetopathy (the size of the shoulder girdle is much larger than the size of the head). In this situation, special benefits are provided, which can result in fractures of the clavicle, humerus or cervical spine.

Cephalohematoma or cerebral hemorrhage in the fetus

The development of such complications is due to anomalies of the birth forces, disorder and subsequent. When the head is configured, there is an excessive displacement of the cranial bones and a sharp compression of them, which causes hemorrhage in the brain or under the periosteum.

Birth management

In the case of the diagnosis of a large fetus, what will be the delivery: operative (caesarean section) or through the natural birth canal (spontaneous birth) depends on many factors. Carrying out the planned:

• large size of the fetus in women under 18 and over 30 years of age;
• combination of breech presentation and a large child;
• prolongation of pregnancy with a large child;
• anatomical narrow pelvis, regardless of the shape and degree of narrowing, and the large weight of the child;
• anomalies in the development of the uterus, myomatous nodes and a large fetus;
• indications requiring the exclusion of the straining period (cardiovascular pathology, high myopia) and a large child;
• large fetal weight and aggravated obstetric history (birth of a dead child in the past, and the use of assisted reproductive technologies).

A caesarean section for emergency indications is performed for any complication during childbirth (threatening uterine rupture, improper insertion of the head, etc.).

In the first 2 hours after childbirth (early postpartum period), there is a high risk of developing hypotonic uterine bleeding, which is due to prolonged labor and excessive uterine distension.

When drawing up a plan for childbirth through the birth canal, take into account:

• childbirth should be carried out under the monitoring control of the child's condition and;
• in childbirth, it is obligatory to maintain a partogram (drawing up a schedule taking into account the time of each period of childbirth, disclosure of the uterine os, intensity of contractions);
• during childbirth, re-measure the size of the pelvis;
• adequate and timely anesthesia and the introduction of antispasmodics;
• in the pushing period, prophylactic administration of reducing agents in order to prevent weakness of attempts;
• early diagnosis of a clinically narrow pelvis;
• prevention of bleeding in the afterbirth period and in the first 2 hours after childbirth.

Children born with a weight of 4 kg or more are at high risk for morbidity and mortality at an early neonatal age (up to 28 days of life), the development of birth injuries (cephalohematoma, cerebral hemorrhage, fractures of the shoulder, collarbone), the development of metabolic disorders and pathology of the central nervous system.

Question answer

Is hospitalization necessary before delivery when pregnant with a large fetus?

Yes, all women diagnosed with a large baby are advised to go to the hospital in advance, at 38-39 weeks. The doctor will carefully measure the size of the pelvis and abdomen, assess the condition of the pregnant woman (the presence of extragenital diseases and complications of pregnancy), the readiness of the cervix (maturity) and draw up a plan for the management of childbirth. And if there is evidence, the decision on the issue of a planned caesarean section and preparation for it.

How can the development of a large fetus be prevented?

First of all, it is necessary to adhere to a balanced diet from the first days of pregnancy. Food should contain the necessary amount for a pregnant woman of proteins, fats and carbohydrates. Future mom should give up overeating, excessive passion for sweets, pastries, fatty and fried foods, and if the condition allows, do special exercises for pregnant women and avoid hypodynamia (frequent and prolonged lying and sitting).

This is my first pregnancy and I have a large fetus. Will I have to have a caesarean section?

No, it is not necessary at all, especially in the first childbirth of young women. Most often, pregnancy and the birth of a large fetus in young healthy women proceed without complications and end happily.

A large fetus is a fetus that has a body weight of 4000 grams or more at the time of its birth. Often for a woman, even a baby weighing 3800 is already heavy, and it is not easy to give birth, however, the weight limit beyond which this diagnosis is made is 4000 ... If the weight of the newborn exceeds 5 kg, they talk about a giant fetus, there are known cases of the birth of babies whose body weight exceeded 7 kg .

Excessive weight of the baby in modern obstetrics is becoming a problem, because more and more babies are born with a lot of weight. At the same time, the large size of the child makes childbirth difficult, can cause complications, birth trauma, and can even be a reason for a caesarean section. Statistics show that every fifth child today is born weighing more than 4 kg.

Large fetus during pregnancy, causes

Why are women now increasingly giving birth to massive children and is it good? Improving human living conditions, easy availability of any food, changing eating habits and a large number of expectant mothers suffering from excess weight have led to this pathology.

We no longer give birth to 8-10 children, as we once did, we enter pregnancy as healthy as possible, and we take care of the child, trying to eat as well as possible and taking vitamins.

The slightest deviation in the condition of the child, the placenta is a reason to prescribe drugs that improve blood circulation in the placenta, to impose on a woman a regimen with restriction of motor activity. And the baby in the stomach is only engaged in gaining weight, it is laid in it, to grow and take the maximum for its growth that its mother can give it. And now she can give him literally everything.

Childbirth at an older age, which is so common now, in itself contributes to the birth of massive babies, affects the weight of the child and overmaturity, and hereditary predisposition.

This is facilitated by the prevalence of such a disease as diabetes mellitus. Once upon a time, not very long ago, literally in the last century, women were supposed to fast during the last weeks of pregnancy. It was precisely those foods that contributed to the weight gain of the child, such as fatty and sweet foods, wheat flour, butter, that were limited ... A modern pregnant woman does not even think about such a diet, and the arrow of the scales does not scare at all after childbirth excess weight can be dropped as well.

Women used to work until the day they gave birth. Today, starting from the 30th week, we get the opportunity to lie quietly on the couch, and eat, eat, eat ... And only when childbirth begins, the "big baby" becomes the body's response to these features of our life and pregnancy in modern conditions.

The reasons for the birth of large children may also lie in deviations in the development of the baby himself, his illnesses.

You are at risk if:

You are overweight
- the child has a tall and strong father
- you have diabetes
- you are going to have a second birth
- in your family, women usually give birth to children with a large weight
- if you are postponing this pregnancy

Large fetus, ultrasound diagnostics

A large fetus during pregnancy is diagnosed using ultrasound and calculations for the circumference of the abdomen and the height of the fundus of the mother's uterus. The trend towards deviation from the norm begins to be clearly observed only from the middle of pregnancy, before that all children develop approximately the same.

On ultrasound, the excess weight of the baby is diagnosed when the size of the circumference of the baby's head, tummy, the length of his thigh ceases to correspond to the gestational age, he overtakes him.

Large fetus and caesarean section

If you are told that the baby is overweight, a cesarean is not necessarily an inevitable outcome, often women are quite able to give birth even to a very large child through the birth canal. As a rule, this is a relative indication for caesarean section, and a caesarean section must be performed if other factors are present at the same time, such as, for example, a narrow pelvis or breech presentation.

The problem due to the large size of the child may arise during the birth itself, the clinical discrepancy between the fetal head and the mother's pelvis will lead to the need for surgery, and the massive body can simply get stuck with the shoulders, and this often ends with a fracture of the baby's collarbone.

The decision on how to conduct labor in the presence of a large fetus is made at 38 - 40 weeks of pregnancy, most likely, you will be hospitalized before the onset of labor, in advance.

How to make sure that the child is born with a normal body weight?

You should not perceive pregnancy as a disease, continue to be active, move. Eat right, do not lean on fatty and fried foods, avoid sweet and starchy foods, do not eat for two and make sure that only wholesome and healthy food is on your plate. If you have diabetes, despite the fact that during pregnancy you will definitely feel very good, strictly follow the dosages of drugs prescribed by your doctor, do not give up medicines.

And most importantly, stay positive. We are all very different, very individual. Perhaps everyone in your family gives birth to big babies? And you will give birth, you will cope on your own without any complications, because for you it will be the norm.