Second trimester of pregnancy (week 13 to week 28)
Sickness and tiredness during the first trimester usually improve in the second trimester. You will start to see more obvious changes in your physical appearance during this trimester as you gradually see your tummy increasing, and later start to feel your baby moving.
What happens during the antenatal visits in second trimester?
- During each visit, your doctor will check your BP, check the growth of your baby by examining you and listen to your baby’s heartbeat.
- Lab tests: routine blood and urine tests advised are as follows:
Triple/quadruple marker test: These are the blood tests to screen for any chromosomal anomalies like Down’s syndrome in the baby. The triple test is done between 16 to 19 weeks and quadruple test is done between 16 to 22 weeks. These are generally advised only if you have missed your combined test (double marker test) for Down’s syndrome during the first trimester.
Hemoglobin: It is done to detect anemia. Further tests may be required in case your hemoglobin is less than 10 gm/dl.
Glucose tolerance test (GTT): women who are genetically prone to develop diabetes or who are overweight may develop diabetes temporarily during pregnancy. This is called gestational diabetes, which if not diagnosed or controlled can have adverse effects on pregnancy. GTT is done to diagnose gestational diabetes. The test involves a total of 3 blood samples. The first sample is taken on an empty stomach after fasting for 8 to 10 hours. You are then given 75 gm of glucose dissolved in a glass of water to drink. The second and third samples are taken one hour and two hours after the glucose drink. During these two hours, you will not eat anything else and avoid activity. If any of these three blood sugar levels are high, your doctor will advise you appropriate measures to normalize the blood sugar levels.
Urine for protein: Presence of protein in your urine may indicate an infection or may be found in those who develop high blood pressure during pregnancy.
Level ll ultrasound: It is a detailed scan of the baby done between 18 to 19 weeks to exclude any birth defects. The detection rate of the abnormality depends on the type of defect, BMI of the mother and position of the baby at the time of scan. Though expertise in this area has increased considerably over the years, it is not possible to identify all birth defects on an ultrasound.
Immunization during pregnancy
During second trimester, you will receive one dose of tetanus toxoid at 24 weeks and one dose of Tdap (triple vaccine) at 28 weeks. But if you have delivered within 5 years and have received full course (TT & Tdap) in your last pregnancy then you need only one booster dose of Tdap at 28 weeks.
Supplements during second trimester
Iron , Calcium ,Vitamin D, Fetal movements
Most of the women begin feeling the fetal movements around 18-22 weeks of gestation. If you are a second time mom, you may be able to appreciate them earlier. Baby’s movements may feel like a kick, flutter or movement of gas in your tummy.
If you are Rhesus(Rh) negative and your partner is Rhesus positive, you will receive an anti D injection at 28 weeks.
Physical changes in your body
This is the best time in your pregnancy with the morning sickness subsiding and your energy levels improving. You may experience certain physical changes in the body like:
1.Skin changes
Pigmentation over the face known as chloasma or pregnancy mask.A dark line running from your belly button to pubic hair called linea nigra.As your belly and breasts enlarge, stretch marks may appear due to stretching of the overlying skin. There is not much you can do about it. There are many creams, lotions and oils sold that claim to prevent or reduce stretch marks, however there is no proof that these treatments work. Most stretch marks fade slowly after delivery, but some may remain.
2.Changes in the breasts
The breasts start enlarging due to increased fat deposition. Darkening of the nipples and the skin around the nipples. Small glands around the skin around nipples become prominent and may be felt as raised bumps (Montgomery’s tubercles).
The breasts may become a little tender and produce some secretions as they start preparing for lactation after delivery.
Management of common problems in pregnancy
Swelling and edema: Swelling of the ankles and fingers is common during pregnancy. Sitting with your feet up might help with ankle edema.
Leg cramps: Leg cramps are common as the pregnancy progresses. To help prevent leg cramps, stay physically active and drink plenty of fluids. A warm bath or massage also may help to relieve the symptoms.
Warning signs during pregnancy
Is you experience any of the following symptoms, inform your doctor or visit the hospital emergency:
Severe headache , Problems with vision like blurring or flashing before the eyes , Rapidly increasing swelling of the face, hands or the feet, Any vaginal bleeding , Lower abdominal cramps not relieved on rest
The doctor on duty will examine you and ensure that all is well, in which case you will be allowed to go home.
Exercise during second trimester
Unless contraindicated, you can continue your exercise regime as earlier. (refer pregnancy care 1st trimester) You should avoid exercises, which involve lying flat on your back for a long time, particularly after 16 weeks.
Travel during second trimester
As long as there are no complications or concerns with your pregnancy, second trimester is the safest period to travel. Always discuss with your doctor before making travel bookings.
