Pregnancy in the 23rd week

In the 23rd week of pregnancy, your baby should be about 28.9cm long from head to toe, which is roughly the size of a squash. Even though your baby’s head is larger in proportion to the rest of his or her body, the limbs would have now developed well enough to be in proportion with the rest of the body. 

Your baby weighs roughly 500g now, and will continue to gain weight for the rest of your pregnancy. Your baby’s skin is probably still quite wrinkled, but it will begin to slowly fill out as he or she gains weight. The lanugo, or hair on your baby’s skin, will now start to darken and may be visible in an ultrasound now.

While you can feel your baby kick and move around in your womb during this week, you just need to wait a few more weeks before you’ll even be able to see how active your baby is when your belly starts moving when he or she does. Make a note of the hours when your baby is most active, what stimuli he or she responds to, etc. This is because in case your baby’s kicks become slower or if he or she is inactive, it might indicate a serious problem. Call the doctor or emergency services immediately if this occurs.

As your uterus continues to grow, you’ll experience more pressure on your lungs and bladder. The former is likely to cause shortness of breath, while the latter will result in frequent urination during pregnancy. Both of these can increase your discomfort. It’s also possible to leak amniotic fluid around this time, which can be a cause of concern. It might be a bit difficult to ascertain if what’s coming out is amniotic fluid or urine, so keep a check and call the doctor or emergency health services if you think you may be leaking amniotic fluid.

If you are leaking amniotic fluid, it could suggest a weak cervix, which is why getting your cervical opening checked during this stage of your pregnancy is important. It’s equally important to start pelvic floor exercises to strengthen your pelvic muscles. This apart, the regular symptoms of the second trimester are likely to show up during this week. The best way to deal with everything this week throws at you is to put your feet up, rest, eat properly, get exercise, and drink sufficient amounts of fluids and water.

You may not experience symptoms of the first trimester, like morning sickness, during the 23rd week of pregnancy, but you will experience many others. The best way to deal with these symptoms is to take proper prenatal care, rest up and get medical attention immediately if any signs of complications show up. The following are some of the most common symptoms of the 23rd week of pregnancy. 

• Sciatic nerve pain: As your baby grows in weight, it starts to put extra weight on your sciatic nerve—which is a nerve travelling down to your legs from underneath your uterus. This can manifest in the form of pain along the path of the sciatic nerve. The pain can be constant or may occur in bouts.
• Varicose veins: The growing weight of the baby and hormonal changes may lead to the development of varicose veins during pregnancy in some women. The condition is characterized by the presence of swollen veins in the legs, vulva or rectum—you can see these veins in purple or blue colour on the skin. Haemorrhoids or piles are a type of varicose veins that occur in the rectum.
• Round ligament pain: A lot of women experience a sharp pain in their groin area or lower abdomen during the second trimester of pregnancy, which is called round ligament pain. This pain usually occurs due to the stretching of a structure called the round ligament and tends to increase on walking or moving. Though it is completely normal and nothing to worry about, it is best to talk to a doctor in case of excessive discomfort.
• Braxton Hicks contractions: These contractions usually show up in the third trimester of pregnancy, but can also show up during the second trimester sometimes. When these contractions during pregnancy occur, your uterus muscles can tighten for 30 or 60 seconds—some contractions might even last for up to two minutes. Although harmless, you should definitely consult your doctor if these contractions show up, intensify in pain and in frequency.
• Sleep problems: Stress and anxiety related to pregnancy and labour may cause you to lose sleep in the second trimester. Also, the pain, cramps, gastroesophageal reflux disease (GERD), and fetal movements may disturb your sleep. 
• Fatigue: Fatigue is yet another symptom that you’re likely to notice this week. Though a lot of women experience much less fatigue during the second trimester, don’t be amazed if you do. It is completely normal to be tired when your body is working so hard to support the life growing inside you.
• Melasma: Also called the "mask of pregnancy", melasma is experienced by a lot of women during the second trimester. It is characterized by the appearance of dark and irregular patches on the forehead, cheeks, lips and nose. Melasma occurs due to the hormonal changes during pregnancy.
• Other symptoms: While the above are some symptoms that might show up in the second trimester, some symptoms from the first trimester are likely to persist and even get worse. This includes bleeding gums, swollen gums, heartburn, indigestion, bloating, constipation, sore breasts as your body prepares for breastfeeding, headaches, nosebleed and mood swings.

Every complication of pregnancy has its own risk factors, and you need to be aware of them all so that you can get timely medical aid and attention. The following are some of the most common complications of pregnancy that are likely to occur during the 23rd week of pregnancy.

• Stillbirth: The sudden loss of a foetus after the completion of 20 weeks of pregnancy is termed stillbirth. World Health Organization (WHO) data from 2015 show that 2.6 million stillbirths occur every year. India has among the highest rates of stillbirths in the world, at an estimated 22 stillbirths for every 1,000 births. A stillbirth can obviously be heartbreaking, and the couple who experiences it should seek counselling, if possible. Regular checkups and taking good care of your health are your best bet to avoid this complication.  
• Hypertensive diseases: Expecting moms have about 50% extra volume of blood. They are at risk of high blood pressure, which can lead to further problems like pre-eclampsia, which is marked by an increase in blood pressure during or after the 20th week of pregnancy. This condition can damage the liver, kidneys and brain in the mom-to-be. It also increases the risk of placental abruption—a condition in which the placenta becomes detached from the womb before delivery.
  Eclampsia, a complication of preeclampsia, may lead to seizures.
  Gestational hypertension (high blood pressure in pregnancy) can also slow down baby development in the womb, and lead to other problems such as going into premature labour and low birth weight (under 2.5 kilograms) of the baby.
• Subchorionic haemorrhage: The chorionic membrane is one of four fetal membranes that protect and support the baby inside the womb. The chorionic membrane helps to form the placenta. If the placenta gets even partially detached from where it got attached to the uterus in the first place, it can lead to some bleeding. Small hematomas (or bleeds) are usually nothing to worry about. However, bleeding in the second and third trimester can quickly lead to other problems. Visit your doctor if you notice any vaginal bleeding.
• Infections: In addition to taking good care of your health and hygiene to avoid infections, it is important to get yourself tested for infections that you could transmit to your baby. These include hepatitis B, hepatitis C, genital herpes and group B streptococcus or GBS bacterial infection. If you have any of these infections, knowing about them will help your gynaecologist recommend the appropriate medicines to reduce or completely avoid their effects on your baby. 
• Obstetric cholestasis: Also known as intrahepatic cholestasis, this condition affects less than 1% of pregnant women in India. Among those affected, the pregnancy hormones reduce the production of bile in the liver. This, in turn, increases the quantity of bile salts in the body. This can present as pruritus, or itchiness without a skin rash. In some cases, this condition can increase the basic risk of going into premature labour. The condition usually starts during or after the 28th week of pregnancy and typically resolves on its own after the birth of the baby.

If you’re getting enough exercise, eating a proper pregnancy diet and getting ample rest, you should be fine during the 23rd week of pregnancy. The following are some of the things you should definitely get done this week, to make sure this week and the rest of your pregnancy goes well:

• Consult your doctor and start doing pelvic floor strengthening exercises. It might be a good idea to get your cervical opening checked during this week as well, to see if there is anything more that needs to be done to ensure that the rest of your pregnancy is safe. In women with a weak cervix, the doctor may suggest a cervical cerclage or stitch to prevent the cervical from opening too soon.
• Stay well away from any foods that are deemed risky during pregnancy. This includes raw foods like raw fish, raw seafood and raw eggs, as well as soft cheeses. These can increase the risks of infections like salmonella and listeriosis. (Read more: Is it safe to eat fish during pregnancy?)
• If you suspect you have an infection, depression or any symptoms of any complications, call the doctor and ask if you can come in for a check-up. This is important because delaying treatment can make the symptoms of most diseases worse, and timely treatment can protect your health as well as that of your baby.
• Get comfortable maternity clothes and a good maternity bra as well. Don’t wear tight-fitting clothes because that can increase the swelling in your limbs and cause more pain.

Now that you can feel your baby kick, you are likely to feel more of an attachment with him or her. Make a note of what your baby responds to and find out more interesting ways to engage with your baby. Make sure you keep in touch with your obstetrician and follow their recommendations. It’s important to stick to the medications and dosage recommended by your doctor because he or she wants the best outcome for you and your baby.

Staying active during pregnancy is very important, but remember to avoid strenuous activities and exercises as your pregnancy progresses. Take your mental and emotional wellbeing very seriously, and communicate with your spouse, family, friends or a maternity support group if you do see symptoms of depression during pregnancy emerge.