I had a tiny pile that developed during 2nd trimester of pregnancy (I have had the same before becoming pregnant that would come and go…)
I was induced and had a relatively short period of pushing, 10-20 minutes, managed to get the baby out with help (ventouse), which required an episiotomy. Feet in stirrups. Nurse and doctor instructing me to push like I was trying to get a poo out! (Pretty much the worst position and action for cashing piles)
I had terrible piles after my delivery, really nasty, it was the the thing that I was most upset about post birth. Scheriproct and pelvic floor exercises helped a great deal. (Extend the exercise so that you squeeze the muscles towards the back too)
My baby is 5 months now and episiotomy scar healed nicely but I still have a tiny pile that pops out every now and then!! It’s not bad enough for me to be too upset, so I don’t regular use cream or exercises to get rid of it, but I should however I’m sure it will eventually go away.
When I think about having another baby, it is the thought of dealing with the piles again that puts me off!!
In your situation I would try and treat it as best you can now. See GP or midwife for stronger cream… I’m not sure what the treatment is for thrombosed piles.
Keep up pelvic floor exercises, and ensure plenty fibre and water so that your bowel movements are regular and you don’t have to strain.
I think that you should be prepared for them getting worse after delivery (unless you have a c-section) but know that it will probably get better, there are treatments for them, in the absolute worse case you might need surgery, but you won’t be stuck with them forever.
If you suspect you might need a c section might be worth going straight for it rather than push push push, make piles worse, then section anyway.
All the best for the rest of your pregnancy and a safe delivery.