38 week woes

I go to the doctor again tomorrow. I thought about waiting to post until then, but I am bored and wanted to give a little update. I'm holding up fairly well, although I swear my belly gets bigger by the day. Tom said I look like I've grown a lot in the last few days, and my body definitely agrees. It is increasingly more difficult to, well, do anything! Mostly, I have trouble transitioning from one position to another, like from sitting to standing. This is only a problem because I can't seem to stay comfortable for long, and I need to switch positions a lot.

My biggest complaint is this itchy stomach of mine. As I reported last week, I have developed a few stretch marks, although they are not terrible. What is terrible is the itching they cause. At first I thought it was just the stretch marks, but I am beginning to fear it is something called "PUPPP", or pruritic urticarial papules and plaques of pregnancy. Here is some information I found about it:

This is the most common rash in pregnant women. It normally occurs in first pregnancies during the third trimester with an average onset of 35 weeks. Thankfully, PUPPP does not usually affect subsequent pregnancies.

Appearance of PUPPP
The rash of PUPPP almost always begins in the stretch marks (striae) of the abdomen. It does not involve the belly button distinguishing it from other common rashes of pregnancy. The rash itself consists of small, red wheals in the stretch marks that grow together to form larger wheals on the abdomen. Sometimes the rash can include small vesicles. Over the next several days, the rash can spread over the thighs, buttocks, breasts, and arms. The rash is very itchy, or pruritic, hence the name. This condition is harmless to mother and baby, but can be very annoying. It lasts an average of 6 weeks and resolves spontaneously 1 to 2 weeks after delivery. The most severe itching normally lasts for no more than 1 week.

Cause of PUPPP
The cause of PUPPP is unknown. It is not associated with preeclampsia, autoimmune disorders, hormonal abnormalities, or fetal abnormalities. Some investigators suggest that the rapid abdominal wall distension damages connective tissue and causes an inflammatory response. One study has shown that male fetal DNA can be found in skin biopsies of the rash. Since 70% of women with PUPPP give birth to boys, a new hypothesis is that male fetal DNA acts as a skin irritant.

Diagnosis of PUPPP
The diagnosis of PUPPP is clinical, meaning it is based solely on the appearance of the rash. There are no laboratory tests that detect PUPPP. Skin biopsies are not generally performed unless there is a question about the diagnosis.

Treatment of PUPPP
The treatment of PUPPP is symptomatic. High strength steroid creams or ointments used up to 5 to 6 times a day usually relieve the itching and prevent the spread of the rash. Once the rash is under control, changing to a lower strength steroid used less frequently is advisable. For severe cases, daily oral steroids may be necessary to control itching. Oral antihistamines are generally less effective for itching than steroids, but may be useful at night to help with sleep.

Sounds lovely, doesn't it? I'm hoping maybe I don't have this, but the red lines of fire on my belly look eerily similar to the pictures I found online. At least, I am at 38 weeks, so even if it is PUPPP, perhaps it will not spread to terribly. It seems to be concentrated just on my stretch marks for the moment, which seems to be how it starts. I plan to ask the doctor about this tomorrow. Calamine lotion has helped somewhat, but maybe they can give me something else. Or maybe I could just have the baby. That would definitely help the rash go away :) I'll update you again tomorrow!