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Pregnancy

During pregnancy, women can experience overwhelming empowerment and joy as a new life grows inside their body. They can also experience scores of uncomfortable symptoms, physical changes and moments of fear and anxiety during one of their most vulnerable stages in life.

To decrease the chances of complications, women should practice proper prenatal care, avoid dangerous drugs and choose the best method of delivery for them. Thankfully, there is a wealth of information available for women to make the best decisions to ensure a healthy pregnancy.

Page Contents:

Facts about Pregnancy

Pregnancy is a constant, nine month process involving doctor visits, lifestyle adjustments and physical changes. Women who are pregnant often have numerous questions as they seek to learn as much as possible about what to expect, what’s considered normal and what they can do to protect their future child and themselves. Today, women have access to more information and resources about pregnancy than ever before.

Quick Facts About Pregnancy:
  • Pregnancies last three trimesters, for a total of about 40 weeks.
  • Common side effects of pregnancy include nausea, vomiting, swelling, varicose veins, backaches, hemorrhoids, heartburn, fatigue, constipation and sleep loss.
  • Proper prenatal care and avoidance of harmful substances and drugs can help increase the chance of a healthy pregnancy.
  • Pregnancy complications can occur from improper prenatal care and preexisting conditions, or for no obvious reason at all. But most complications are treatable if detected early.
  • There are a variety of methods for giving birth, ranging from natural births to C-sections and water births to deliveries in a hospital bed.
  • Women should maintain an open relationship and regular contact with their healthcare provider throughout their pregnancy.

Timeline of a Pregnancy

Pregnancy is the time period in which a woman carries a fetus inside of her uterus. It usually lasts about 40 weeks – just over 9 months – and is divided into three trimesters.

Pregnancy occurs when a man’s sperm penetrates a woman’s egg, the egg travels through the fallopian tube to the uterus and it implants itself in the uterine wall. The fertilized egg, called a zygote, is made up of a cluster of cells that form the fetus and the placenta. The placenta is an organ that develops during pregnancy to provide nutrients and oxygen to the fetus while it grows.

Signs of Pregnancy

A woman usually knows she is pregnant when she misses a period or multiple periods. However, missing a period does not always mean a woman is pregnant, and women experience other symptoms of pregnancy before missing a period. Some women experience multiple symptoms and some don’t experience any.

Women should talk to their doctor if they notice any of these signs, because they may be symptoms of other medical conditions. Many women use a home pregnancy test before calling their doctor. The tests do not require a prescription and are very accurate.

Early signs of pregnancy include:

First Trimester

The first trimester lasts 12 weeks, beginning with conception.

Women should schedule their first doctor visit sometime during weeks 6-8 or after their menstrual period is two to four weeks late. Some doctors will not schedule the first exam until week eight unless there is an issue.

During the first visit, the doctor will ask many questions about the woman’s health, habits and menstrual cycle. The doctor will also perform a number of tests or exams. Women of different ethnic backgrounds often take different tests because they may be at a higher risk for certain diseases.

Initial pregnancy exams and tests include:
  • A physical
  • A pelvic and rectal exam
  • A complete blood cell count
  • A urine sample
  • A pap test
  • Blood typing and screening
  • A test for infections like syphilis, hepatitis, gonorrhea, chlamydia and HIV
  • A test for previous exposure to chickenpox, measles or mumps
  • A test for cystic fibrosis

Exam Timelime

If the initial exam does not produce warning signs women generally see the doctor on a set schedule. Between the 10th and 14th weeks, women may be screened for substances that could point to risk factors for later complications. Around 12 weeks, some women are tested for gestational diabetes, a type of diabetes that forms during pregnancy.

Pregnant women typically see their doctor:
  • Every four weeks until the 28th week
  • Every 2 weeks from weeks 28-36
  • Once a week from week 36 to delivery

Second Trimester

The second trimester lasts between weeks 13 and 28.

As early as week 12, but usually around week 16, a doctor can determine the sex of the fetus. Bones, muscle tissue and skin have formed by then.

Women usually feel movement around the 20th week. Around the 24th week, footprints and fingerprints are formed and the fetus sleeps and wakes frequently. The size and shape of the woman’s uterus may also be measured in the 22nd week to determine whether the fetus is growing and developing normally.

The 28th week is usually the earliest a baby can be born, with an estimated 92 percent of babies surviving birth at that time. However, most are born with serious health complications.

Second trimester tests include:
  • Doctors may use a needle to retrieve a sample of amniotic fluid from the womb between weeks 15 and 20 to test for substances that could lead to future complications.
  • Additional tests are often performed between 16 and 18 to look for potential abnormalities or birth defects.
  • An ultrasound or sonogram is usually performed between weeks 18 and 20 to verify the expected delivery date and the baby’s anatomy, to record heartbeats and breathing movements, to check for additional fetuses and to identify potential abnormalities.
  • If a first trimester diabetes test was not performed, women typically undergo the test between weeks 24 and 28.

Third Trimester

The third trimester lasts between weeks 29 and 40, or until birth.

Around the 32nd week, the fetus’s eyes can open and close and the bones are almost fully formed. An infant born before the 37th week (preterm) is at an increased risk for developmental, hearing and visual problems.

Infants born during the 37th and 38th (early term) weeks face less serious health risks, but are usually not as healthy as babies born in the 39th and 40th weeks (full term). Babies born during the 41st week (late term) and after 42 weeks (post term) are also at a higher risk for complications.

Prenatal Care

Almost a third of women who become pregnant experience some kind of complication. Prenatal care helps prevent the risk of pregnancy complications and increase a doctor’s chance of detecting complications if they occur.

Prenatal care refers to the healthcare women receive while pregnant. It includes checkups, screenings, and dietary and lifestyle changes. In a perfect world, women would begin prenatal care before they become pregnant. When that is not possible, women should begin prenatal care as soon as they realize they are pregnant.

Healthcare providers for pregnant women include:
  • Obstetricians: doctors that concentrate in pregnancy and childbirth
  • Obstetricians/gynecologists (OB/GYNs): doctors that concentrate in pregnancy and childbirth, in addition to women's health care
  • Family practitioners: doctors that offer a variety of services to people of all ages, usually a pregnant woman’s general practitioner
  • Midwives: may be licensed, professional midwives or certified nurses that concentrate in women’s healthcare, pregnancies and childbirth

Prenatal Supplements & Medication

A prenatal checkup before pregnancy involves testing for any diseases or conditions that could affect a pregnancy. Most women decide to either change or discontinue medications or potentially unhealthy habits during this visit. They may also begin taking prenatal vitamins, folic acid, calcium or iron supplements.

Recommended prenatal supplements include:
  • Folic Acid: helps prevent neural tube defects which affect the development of the spine and nervous system
  • Calcium: helps the fetus develop strong bones, nerves and muscles
  • Iron: helps carry oxygen to blood cells
  • Prenatal vitamins: usually contain adequate balances of folic acid, calcium and iron but lower doses of other vitamins and minerals that could be harmful

Weight Gain & General Health

Weight gain is a typical and healthy aspect of pregnancy. Most women should gain 25-35 pounds during pregnancy, but overweight women should only gain 15-25 pounds and underweight women should gain 28-40 pounds.

Although many women worry about gaining weight, a failure to do so could result in inadequate fetal growth or premature labor. Accordingly, most women should not start a weight-loss diet during pregnancy. Rather, they should begin a healthy diet if they do not already practice one.

Women should avoid foods that could contribute to foodborne illnesses, like unpasteurized cheese, milk or juice and raw meats including fish, eggs and deli meats. Additionally, some seafood contains high amounts of mercury which may harm the fetus.

General recommendations for a healthy pregnancy include:
  • Don't smoke
  • Don’t drink alcohol
  • Don’t abuse drugs
  • Get plenty of rest
  • Eat a healthy diet
  • Perform low-impact exercises

Drug Use

Women should always consult their doctor before starting or stopping any medication or treatment while pregnant. As with all drugs, the doctor will help determine if the benefits of the drug outweigh the risks to the mother and fetus. Women who take medications regularly should schedule an appointment with their doctors before attempting to get pregnant.

There are no hard-set rules for when and when not to use most drugs. For example, a woman and her doctor may decide she will not take an over-the-counter (OTC) drug for a cold that she would have taken if she weren’t pregnant. OTC drug labels most often tell women to talk to their doctor before using the drug.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin can cause serious problems with blood flow after the 28th week of pregnancy. Additionally, it is not clear if nicotine medications are harmful to pregnant women, so pregnant women who smoke should try to stop without medical help first

Vitamins recommended for women contain doses of many minerals and vitamins that are too high for pregnant women. Additionally, natural and herbal supplements do not go through any kind of approval process before being sold, so they are not recommended for pregnant women. Even herbal or natural supplements that claim they help with pregnancy lack academic or scientific proof.

Prescription Drug Classifications

Prescription drugs often carry more serious side effects than OTC drugs. To help doctors determine which drugs are safe or dangerous for pregnant women, the FDA developed categories in 1979. The categories were supposed to help communicate the degrees of fetal risks, but the FDA determined the categories - and other aspects of the label - lacked clarity and failed to provide meaningful information.

The FDA ordered drug manufacturers to remove the categories beginning June 30, 2015. The manufacturers have 3-5 years (depending on when the drug was approved) to remove the categories. The FDA hopes a new "narrative" description on the label will more effectively communicate risks and benefits.

Label Changes Include:
  • The "Pregnancy" section will now include labor and delivery information.
  • The "Nursing Mothers" section will be renamed "Lactation" and will include information for nursing mothers.
  • A new section will be added called "Females and Males of Reproductive Potential."
  • The pregnancy categories will be phased off of labels from 2015-2020.
Category Definition Examples
A Studies did not indicate any risks associated with this drug to pregnant women or fetuses. Folic acid, Levothyroxine (used to treat hormone imbalances
B Animal studies indicated a risk to the fetus, but human studies did not OR there are no studies in humans but animal studies did not indicate any problems to the mother or fetus. Amoxicillin, Zofran, Glucophage
C Animal studies indicated a risk to the fetus, and there are no human studies. But, the benefit might be better than the risk in humans OR there are no animal studies or studies in pregnant women. Diflucan, Vatolin, Zoloft, Prozac
D Human studies indicated some fetuses are harmed, but in serious situations the benefit might be greater than the risk Paxil, Benicar, Lithium, Dilantin, Cancer treatments
X Studies indicated a risk to the fetus, and pregnant women should never use this drug. Accutane, Thalomid, Testosterone
N No classification Aspirin, oxycodone, acetaminophen

Category A

Definition

Studies did not indicate any risks associated with this drug to pregnant women or fetuses.

Examples

Folic acid, Levothyroxine (used to treat hormone imbalances

Category B

Definition

Animal studies indicated a risk to the fetus, but human studies did not OR there are no studies in humans but animal studies did not indicate any problems to the mother or fetus.

Examples

Amoxicillin, Zofran, Glucophage

Category C

Definition

Animal studies indicated a risk to the fetus, and there are no human studies. But, the benefit might be better than the risk in humans OR there are no animal studies or studies in pregnant women.

Examples

Diflucan, Vatolin, Zoloft, Prozac

Category D

Definition

Human studies indicated some fetuses are harmed, but in serious situations the benefit might be greater than the risk.

Examples

Paxil, Benicar, Lithium, Dilantin, Cancer treatments

Category X

Definition

Studies indicated a risk to the fetus, and pregnant women should never use this drug.

Examples

Accutane, Thalomid, Testosterone

Category N

Definition

No classification

Examples

Aspirin, oxycodone, acetaminophen

Dangerous Drugs during Pregnancy

Testosterone

The fetuses of pregnant women exposed to testosterone often suffer abnormal development, virilization and abnormal male sex characteristics. Men using topical treatments like gels or creams most often expose women to testosterone accidentally. It carries a category X rating.

Accutane

Antidepressants & SSRIs

Benicar

Crestor

Depakote

Testosterone

Topamax

Zofran

Common Complications

Even when women receive proper prenatal care and avoid dangerous drugs, they could still experience complications during pregnancy. Women who led healthy lives and maintained healthy weight before pregnancy can still experience complications. When a woman experiences complications, her pregnancy is consider high-risk.

High-Risk Pregnancies

A high-risk pregnancy can threaten the mother or the fetus’s life. With proper prenatal care, healthcare providers can detect and treat complications early to improve the chances of a healthy pregnancy.

Factors that contribute to high-risk pregnancies include:
  • Health conditions: like high blood pressure, diabetes or HIV
  • Weight: being underweight, overweight or obese
  • Multiple fetuses: twins, triplets, etc.
  • Young or old age: teens and women older than 35

High Blood Pressure

Hypertension (high blood pressure) occurs when arteries from the heart to organs narrow causing extra pressure. This makes it hard for blood to travel to the placenta and provide nutrients and oxygen to the fetus.

Women with hypertension before pregnancy should monitor and attempt to control it. Some women develop high blood pressure, called gestational hypertension, during pregnancy. About four percent of women develop the condition, and it almost always goes away after childbirth.

Gestational Diabetes

Gestational diabetes is another condition that develops during some pregnancies. It occurs when changes in hormones during pregnancy prevent the body from making insulin or using insulin properly. When this happens, glucose (sugar) builds up in the blood causing high blood sugar.

About eight percent of pregnant women develop gestational diabetes. If untreated, it can cause heart disease, vision problems, kidney disease or preeclampsia.

Preeclampsia

Preeclampsia causes high blood pressure and can lead to premature delivery or a large infant, increasing the need for a cesarean section. Preeclampsia can also lead to protein in urine or edema – fluid buildup in body tissues causing swelling.

Risk factors for preeclampsia include:
  • First time being pregnant
  • Previous history of preeclampsia
  • High blood pressure, diabetes, kidney disease or lupus
  • Being African American
  • Being 35 years or older
  • Carrying two or more fetuses
  • Obesity

Pregnancy Loss

A miscarriage is a loss of pregnancy from natural causes before the 20th week. It occurs in an estimated 20 percent of pregnancies. Signs of a miscarriage include vaginal bleeding, cramping and fluid or tissue passing from the vagina. Bleeding does not mean that a miscarriage is happening, but women should contact their health care provider if bleeding occurs.

After the 20th week, a loss of pregnancy is referred to as a stillbirth. Doctors could not determine the cause of stillbirths in about half of all cases, but factors that could contribute to stillbirths include infections, chromosomal abnormalities, inadequate fetal growth, placental issues and a mother’s health issues.

Depression

Depression involves feelings of sadness, anxiety or emptiness that interfere with daily activities. About 13 percent of pregnant women and new mothers suffer from depression. Symptoms of depression can be mild or severe, but doctors can treat almost all of them. Women suffering for more than two weeks should contact their doctor.

A family history of mental health problems, changes in brain chemistry that occur during pregnancy, stressful life events and hormones all contribute to depression during pregnancy.

Symptoms of depression include feeling:
  • Sadness
  • Restlessness
  • Moodiness
  • Hopelessness

Postpartum Depression

Postpartum depression occurs after childbirth. The rapid change in hormone levels after childbirth or a decrease in levels of thyroid hormones after childbirth may lead to postpartum depression. Other factors like exhaustion, feeling overwhelmed, doubts about capabilities of being a good mom and lack of free time can contribute to postpartum depression.

Women struggling with depression or postpartum depression should:
  • Talk to their healthcare provider
  • Sleep as much as possible
  • Avoid trying to be a “perfect” mom
  • Ask friends and family for help
  • Talk to family and friends about feelings
  • Attempt to find free time
  • Join a support group
Less common pregnancy complications include:
Anemia Iron deficiency can cause a tired feeling, shortness of breath and pale skin.
Hyperemesis gravidarum Although nausea and vomiting are normal during the early stages of pregnancy, some women experience severe, long-lasting symptoms. The cause is unknown, but hyperemesis gravidarum can cause weight loss, dehydration and faint feeling.
Infections Washing hands and avoiding risky foods can prevent most infections.
Urinary tract infections (UTI) Bacterial infections can cause pain, fever and nausea.

Labor

Labor is the process of childbirth in which the fetus and placenta leave the uterus.

During the final weeks of pregnancy, the fetus is still developing its lungs, brain and liver. Thus, a woman should be pregnant for at least 39 weeks before giving birth to ensure the highest chance of a healthy outcome. However, a healthcare provider might recommend inducing labor sooner if there is a health risk to the fetus or mother.

Women can give birth in a number of different ways. The three general categories that most delivery methods fall into are medicated births, natural births and cesarean sections (C-section).

The signs of labor vary from woman to woman. Signs that a woman may be going into labor include:
  • The woman feels relief or lighter, because the fetus moves from the rib cage to the pelvic area
  • The woman notices clear, pink or slightly bloody discharge called show as the cervix begins to dilate
  • Contractions begin
  • Vaginal discharge changes color
  • Pelvic pressure occurs
  • Lower backache occurs
  • Abdominal cramps occur

The Three Stages of Labor

1

First Stage

In the first stage, contractions begin until the woman is dilated 10 centimeters (4 inches).

2

"Active" Stage

In the “active” stage, the woman begins to push until she gives birth.

3

"Placental" Stage

In the “placental” stage, the woman delivers the placenta and afterbirth.

Medicated Birth

A “medicated” birth is the most popular delivery method in the U.S. About 61 percent of women give birth on pain medication, usually in the form of an epidural block, spinal block or general anesthesia. An epidural is injected into the spine, and a spinal block is injected into the spinal fluid. If given anesthesia, the woman is asleep during the delivery.

Although the natural, or non-medicated, method of delivery is growing in popularity, there is no evidence that delivering a baby while medicated affects the baby’s Apgar score – a test that measures a baby’s health immediately after it is born – or increases the chance of a C-section.

Natural Birth

About 39 percent of U.S. women give birth using no medication. Instead, they may rely on relaxation and breathing techniques to reduce pain. Many women feel a sense of empowerment by giving birth without the assistance of medication.

Some women avoid medication, because it may cause their blood pressure to drop, affect the speed of labor or cause them to become nauseous.

Cesarean Section

A C-section is a surgical procedure in which a doctor makes an incision in the mother’s abdomen and uterus to deliver the baby through. After the delivery, the doctor closes the uterus with stitches that eventually dissolve and the abdomen with staples or stitches. About 33 percent of babies are born via C-section.

C-sections are generally considered safe, but like all surgeries, complications can occur. Recovery usually takes longer, infants could be more likely to experience breathing problems and future pregnancies could be affected. Women who have had a past C-section give successful vaginal births about 75 percent of the time.

C-sections usually occur when:

Alternate Delivery Methods

A variety of methods for giving birth outside of a hospital room exist. Each method can be adjusted to fit a woman’s specific wishes or needs, with some involving medication and some occurring naturally. There is not enough evidence to support or oppose claims that any of the methods are superior or inferior to more traditional delivery methods.

Water birth

In a water birth, a woman sits or lays in a heated water bath or pool during labor. Some give birth in the tub or pool, and others get out before delivering.

Women who experience water births say it improves the birthing experience, helps them relax, improves blood flow and helps shorten labor. However, it can have drawbacks if performed improperly. Complications can occur if the baby is born underwater, if the water temperature is too hot or cold or if the tub or water is unsterile.

image of water birth
woman on hospital bed giving birth

Hypno Birth

A hypno birth involves a combination of relaxation, breathing and visualization techniques to control pain. The purpose is to use meditation to enter a calm state. One of the key components is relaxation in order to avoid tensing muscles.

Instead of “pushing” the baby down during labor, the woman “breathes” the baby down. Women attend practice sessions and perform daily exercises in the weeks leading up to the delivery.

Non-Recumbent Birthing Positions

A woman can give birth in a number of different positions. The supine recumbent position is the traditional position for giving birth in most healthcare facilities, because many of the medical devices and monitoring tools used in hospitals limit other options.

However, women squat while giving birth in many parts of the world, including Asia, Africa and parts of South America. There is not a perfect position to give birth in, but some experts recommend changing positions during labor to help with pain.

woman in non-recumbent birthing position
Various positions for giving birth include:
  • Rocking
  • Standing
  • Lunging
  • Kneeling
  • Squatting
  • Leaning forward while sitting
  • Extending legs while sitting
  • Lying on the side

Water Birth

Water birth

In a water birth, a woman sits or lays in a heated water bath or pool during labor. Some give birth in the tub or pool, and others get out before delivering.

Women who experience water births say it improves the birthing experience, helps them relax, improves blood flow and helps shorten labor. However, it can have drawbacks if performed improperly. Complications can occur if the baby is born underwater, if the water temperature is too hot or cold or if the tub or water is unsterile.

Hypno Birth

Hypno Birth

A hypno birth involves a combination of relaxation, breathing and visualization techniques to control pain. The purpose is to use meditation to enter a calm state. One of the key components is relaxation in order to avoid tensing muscles.

Instead of “pushing” the baby down during labor, the woman “breathes” the baby down. Women attend practice sessions and perform daily exercises in the weeks leading up to the delivery.

Non-Recumbent Positions

Non-Recumbent Birthing Positions

A woman can give birth in a number of different positions. The supine recumbent position is the traditional position for giving birth in most healthcare facilities, because many of the medical devices and monitoring tools used in hospitals limit other options.

However, women squat while giving birth in many parts of the world, including Asia, Africa and parts of South America. There is not a perfect position to give birth in, but some experts recommend changing positions during labor to help with pain.

Various positions for giving birth include:
  • Rocking
  • Standing
  • Lunging
  • Kneeling
  • Squatting
  • Leaning forward while sitting
  • Extending legs while sitting
  • Lying on the side

Reflexology

Reflexology

Reflexology is one of the most popular non-medicinal methods of pain relief for delivery, and it can be used in almost any delivery method. It focuses on flexing certain areas of the body, including the hands, feet and various muscles. There are a variety of scientific theories that support the idea that reflexology may help relieve pain.

Acupuncture & Acupressure

Acupuncture and Acupressure

Acupuncture involves inserting very fine needles into the skin and rotating, heating or electrically stimulating them to relieve discomfort. Acupressure involves applying pressure to similar points on the body to relieve discomfort. Both are used to relieve discomfort during labor, primarily in Asian cultures.

Testosterone

Herbs

Herbs

Herbal treatments usually involve a variety of ingredients including roots, leaves, barks, twigs, fruits, berries and flowers. Some people take specific herbal supplements concocted to boost a woman’s strength and energy during labor. Other herbal treatments are used as washes or cleanses.

Aromatherapy

Aromatherapy

Aromatherapy uses scents and smells to boost a woman’s mood during labor. Many women use aromatherapy during labor, but there are no studies that prove its effectiveness.

Alternate Delivery Methods

Reflexology

Reflexology is one of the most popular non-medicinal methods of pain relief for delivery, and it can be used in almost any delivery method. It focuses on flexing certain areas of the body, including the hands, feet and various muscles. There are a variety of scientific theories that support the idea that reflexology may help relieve pain.

Acupuncture and Acupressure

Acupuncture involves inserting very fine needles into the skin and rotating, heating or electrically stimulating them to relieve discomfort. Acupressure involves applying pressure to similar points on the body to relieve discomfort. Both are used to relieve discomfort during labor, primarily in Asian cultures.

Herbs

Herbal treatments usually involve a variety of ingredients including roots, leaves, barks, twigs, fruits, berries and flowers. Some people take specific herbal supplements concocted to boost a woman’s strength and energy during labor. Other herbal treatments are used as washes or cleanses.

Aromatherapy

Aromatherapy uses scents and smells to boost a woman’s mood during labor. Many women use aromatherapy during labor, but there are no studies that prove its effectiveness.

Breastfeeding

Breastfeeding is the most popular way to feed and nourish an infant. Breastfeeding should begin within one hour after birth, and can occur up to 12 times per day in the first weeks of life.

Many infants are breastfed exclusively, receiving no other form of nutrition for the first six months of their lives.

Benefits of breastfeeding include:
  • Protecting the baby from infection and illness
  • Increasing bonds between mother and baby
  • Saving money

Mothers should be extremely aware of their diet while breastfeeding. The diet should include a balance of fruits, vegetables, lean meats, fat-free or low-fat dairy products, whole grains and plenty of fluids. Mothers should avoid seafood high in mercury – like swordfish –, drinks high in caffeine or sugar and alcohol.

If consuming alcohol, experts recommend:
  • Waiting until the baby is at least 3 months old
  • Drinking in moderation – only 1 drink per day
  • Pumping milk for later use before consuming alcohol
  • Waiting at least 4 hours after a drink before breastfeeding

Reminder:

Pregnancy can be a rewarding experience, culminating in bringing a new life into the world. Women must be open with their healthcare provider, cope with dramatic physical changes and make many sacrifices to ensure a successful pregnancy. But the result of their sacrifice is often one of the most rewarding experiences of their life.

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