The Second Trimester
13-26 weeks
The “Honeymoon Period” of Pregnancy when you are starting to feel better, and your energy levels start to improve.
It can be a little scary because you feel so good but may not be able to feel movement or feel consistent movement.
Consistent movement is first appreciated around 18-22 weeks.
14-16WEEKS
You should be starting to feel better and with less nausea.
We will review your blood work, and review with you any issues you are having.
There is a test called a Maternal Serum Quad Screen. This test is optional.
Maternal Serum Quad Screen – This test can be performed between 14 and 22.9 weeks. The developing fetus produces many proteins which naturally pass through the placenta and can be found in the mother’s blood. By measuring four of these proteins (AFP, hCG, estriol, and inhibin A), it can be determined whether the developing fetus is at increased risk of having:
- Neural Tube Defects (NTD) – an opening in the spinal cord or brain that occurs very early in human development.
- Genetic Abnormalities – Down syndrome (Trisomy 21) and Trisomy 18
18-19 WEEKS
You will lie on a table with your abdomen exposed from the lower part of the ribs to the hips. A gel is applied to the surface of the abdomen. This improves contact of the transducer with the skin surface. The handheld transducer then is moved along the abdomen to make images. You may need to drink several glasses of water during the 2 hours before your exam. This will make your bladder full. A full bladder creates a “window” through which structures underneath the bladder or around it can be seen more clearly.
Anatomy Screening Ultrasound
Fetal ultrasound provides the safest way to get details about your fetus and detect any signs of issues with size and position. The sex of your fetus can typically be seen with an ultrasound about 18 weeks into your pregnancy. It is a noninvasive test and does have some limitations.
A second-trimester fetal ultrasound can:
- View the size and position of the fetus, placenta, and amniotic fluid.
- Check the position of the fetus, umbilical cord, and placenta through a blood sampling.
- Find major congenital disabilities.
Learn More about…
…common Symptoms in the Second Trimester
ROUND LIGAMENT PAIN
The round ligament connects the front part of the womb to your groin, the area where your legs attach to your pelvis. The round ligament normally tightens and relaxes slowly.
As your baby and womb grow, the round ligament stretches. That makes it more likely to become strained. Sudden movements like laughing, sneezing, or coughing can cause the ligament to tighten quickly, like a rubber band snapping. The tightening causes a spasm on either one or both sides of the groin causing sharp, stabbing feeling in your lower pelvic.
What can you do?
- Rest is one of the best ways to help with this kind of pain. Changing positions slowly allows the ligaments to stretch more gradually and can help alleviate any pain.
- If you know that you are going to sneeze, cough, or laugh you can bend and flex your hips, which can reduce the pull on the ligaments.
- If you are having consistent round ligament pain you could try daily stretching exercises. The most common exercise is done by placing your hands and knees on the floor, lowering your head to the floor, and keeping your bottom in the air.
SHORTNESS OF BREATH
The state of pregnancy increases a woman’s demand for oxygen. To meet this demand, pregnant women hyperventilate, not by breathing more rapidly but by breathing more deeply.
During this process, however, the total lung volume decreases, which decreases reserve lung capacity. This will often produce the normal symptoms of shortness of breath during minimal exertion.
However, if this symptom becomes persistent, please contact your OB/GYN.
CARDIOVASCULAR CHANGES OF PREGNANCY
Blood volume increases gradually by 30 to 50 percent (1500 ml to 3 units) with a greater increase in serum than red blood cells. This results in a decreased concentration of red blood cells and hemoglobin in the blood.
To accommodate this change, the heart chambers dilate which increases cardiac output by about 30 percent during the first and second trimester. This change can produce symptoms of heart palpitations and feeling lightheaded.
HEART PALPITATIONS
Your heart is working harder in pregnancy.
There is an increased demand for perfusion or blood flow to the growing uterus and the developing fetus. That includes an increase in blood volume of 30% to 50%, as much more blood is pumped to the uterus, and a raised heart rate, from a normal prepregnancy rate of about 70 beats per minute up to 80 to 90 beats per minute.
This will often produce the symptom of palpitations and premature ventricular contraction (PVC) or a skipped heartbeat.
Palpitations are actually a rather subjective sensation, in that everyone may feel it slightly differently, it can feel like a fluttering in the chest, a racing, pounding or fast-beating heart. Sometimes it comes and goes quickly without garnering much attention, but in other instances heart palpitations can be very noticeable – and scary.
FEELING LIGHTHEADED
Because of the increased circulation of blood, urine production is increase, which can often result in dehydration.
Dehydration may produce symptoms of light headedness or fainting.
It is important during pregnancy to maintain adequate hydration.
- Typical fluid intake between 8-12, eight-ounce glasses per day
- Higher amounts are needed when the weather is warm or during exercise, or conditions resulting in extra fluid loss (diarrhea).
- Avoid caffeinated and high-sugar beverages which are dehydrating.
However, if this symptom becomes persistent, please contact your OB/GYN.
FREQUENT URINATION
The pregnancy hormone, hCG, increases the blood flow to your pelvic area combined with increase blood volume and cardiac output, more blood flows into the kidney. As your kidneys get better at their job, your body gets rid of waste more quickly (including baby’s, since you’ll be peeing for two).
Don’t cut back on liquids thinking it’ll keep you out of the bathroom. Your body and your baby need a steady supply of fluids during your pregnancy.
Keep an eye on the color of your urine to ensure you’re staying hydrated: It should be clear and pale yellow, not dark.
If you’re always feeling the urge to go to the bathroom (even after you’ve just peed), or if it seems like the issue is getting worse, talk to your practitioner. We might want to run a test to see if you have a UTI.
HEADACHES
Experiencing headaches at the onset of pregnancy is another common early sign of pregnancy. There are several reasons why pregnant women develop headaches.
- Some experts believe that it is the sudden rise of hormones in your body that causes headaches.
- Headaches during pregnancy may also be caused by an increase in blood flow. There is an approximately 50% increase in the circulating volume of blood while you are expecting.
- Women who suddenly stop their morning coffee and sodas may experience caffeine withdrawal headaches.
- Those who also suffer from nausea and vomiting in early pregnancy can become dehydrated.
- Additionally, because you’re moving more air, your sinuses may be over worked, and inflammation can lead to sinus headaches. Sinus headaches may be more likely because of the nasal congestion and runny nose that are common in early pregnancy. If you think it may by sinus related, try an antihistamine.
You can take:
- Tylenol for your headache.
- Antihistamine (for sinus headache)
When a headache is severe, or just doesn’t go away, or when you have dizziness, blurred vision, or changes in your field of vision, you should contact your healthcare provider.
HEARTBURN
As previously mentioned, Progesterone levels are very high during pregnancy. Progesterone relaxes smooth muscle like your uterus.
Unfortunately, the GI tract from halfway down your esophagus to the anus is all smooth muscles. High levels of circulating progesterone slow the motility of the gastrointestinal tract. As a result, there is delayed emptying of the stomach, which increases the risk of heartburn.
Antacids taken regularly, as needed, with every meal, or at bedtime:
- Antacids
- Rolaids
- Tums
- Maalox
- Mylanta
- H2 receptor agonists and proton pump inhibitors
- Prilosec
- Pepcid
- Zantac,
- Prevacid
SKIN CHANGES
Acne
Many women have acne during pregnancy. Some already have acne and notice that it gets worse during pregnancy. Other women who may always have had clear skin will develop acne while they are pregnant.
If you get acne during pregnancy, take these steps to treat your skin:
- Wash your face twice a day with a mild cleanser and lukewarm water.
- If you have oily hair, shampoo every day and try to keep your hair off your face.
- Avoid picking or squeezing acne sores to lessen possible scarring.
- Choose oil-free cosmetics.
Over the counter (OTC) products containing the following ingredients can be used to treat acne during pregnancy:
- Topical benzoyl peroxide
- Azelaic acid
- Topical salicylic acid
- Glycolic acid
WARNING: The prescription anti-acne drugs isotretinoin and tretinoin can cause birth defects and should never be used during pregnancy.
Spider veins and red spots
Hormonal changes and the higher amounts of blood in your body during pregnancy can cause tiny red veins, known as spider veins, to appear on your face, neck, and arms. They occur when tiny, one-way valves in the veins weaken. When they weaken, some blood flows backward and stays in the vein. This extra blood puts pressure on the walls of your vein, causing it to bulge and become visible on the surface of your skin. The redness should fade after the baby is born.
Strech Marks
You might notice uneven streaks of pink, red, or purple developing along your body as it expands. Your thighs, bottom, breasts, and abdomen are the most common places. Using a heavy moisturizer may help keep your skin soft, but it will not help get rid of stretch marks. Most stretch marks fade after the baby is born, but they may never disappear completely.
Melasma
Due to the hormones in pregnancy, your skin may develop darker patches of pigmentation on the face, shoulders, forearms, or the line running down from your navel. Some women’s nipples, genitals, and freckles become darker or more pronounced. Dark spots and melasma usually fade on their own after you give birth. Some women, however, may have dark patches that last for years.
To help prevent melasma from getting worse, wear sunscreen and a wide-brimmed hat every day when you are outside