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Pregnancy

Second Trimester

Introduction
Second Trimester Month by Month
Physical Changes and Symptoms

Introduction

The second trimester, generally thought of as the 14th week of pregnancy through the 28th, is sometimes called the "golden trimester" of pregnancy. This label is appropriate because many of the symptoms of early pregnancy have resolved and the discomforts of the third trimester, when the growing baby will put increased demands on your body, have not yet begun. During the second trimester, you are likely to find that your nausea is decreasing, you are sleeping better, and your energy is returning. Don't be surprised, though, if a few new discomforts appear. In addition, the baby will probably begin to seem more "real" to you during these weeks. Using a special listening device, your doctor will probably hear the baby's heartbeat for the first time at around 12 weeks. At some point between 16 and 20 weeks, you will feel the first fluttering movements. During the second trimester, you are likely to find that your nausea is decreasing, you are sleeping better, and your energy is returning.

Although there is some risk of miscarriage in the second trimester, it is much lower than in the first trimester. For this reason, many women -- especially those who have previously experienced a miscarriage -- feel comfortable spreading the news about being pregnant during the second trimester. Your enlarging abdomen will begin to be much more noticeable by four or five months. You will need to begin to change your wardrobe during these months and to make plans to prepare your home for your new baby. Now is the time to think about childbirth classes for you and your partner and possibly sibling and grandparent classes for others in your family. You will want to explore the options concerning maternity and paternity leave for you and for your partner after the baby is born and to look into child care options if both of you will be returning to work. There are many plans to be made, and fortunately, this is the time you are likely to feel your energy returning.

Second Trimester Month by Month

A number of exciting changes in your baby's development occur during the second trimester:

Fourth Month (Weeks 14-18)
Your baby, now weighing about 6 ounces, is growing fast and is about 8 to 10 inches long by the end of this month. The umbilical cord will continue to grow and thicken in order to carry enough blood and nourishment.

During the fourth month you will gain 3 to 4 pounds and start to "show." Maternity clothes and a maternity bra may now be more comfortable. You may start to feel a slight sensation of movement in your lower abdomen. This feeling is like "bubbles" or fluttering. When you first feel this movement, called "quickening," write down the date. This date may help the doctor determine when your baby is due.

Fifth Month (Weeks 19-23)
By the end of this month, your baby will weigh about one pound and be about 12 inches long. This month you may gain 3 or 4 pounds and begin to breathe deeper and more frequently. The area around your nipples may look darker and wider as your breasts prepare to make milk (lactate).

Sixth Month (Weeks 24-28)
You are now carrying a fully formed miniature baby except that the skin is wrinkled and red and there is practically no fat under the skin. The baby still needs to grow, since it is only about 14 inches long and weighs about 2 ΒΌ pounds. The baby may cry and suck on its thumb and you will regularly feel the baby's movement.

You may gain 3 or 4 more pounds and experience some backache. Wearing low-heeled shoes will give you a better sense of balance and comfort during this period.

Physical Changes and Symptoms

The second trimester is not always trouble-free. A whole new set of symptoms and sensations are common, as well as potential problems and complications. Like the changes of the first trimester, those of the second, and the particular way in which you experience them, will be unique to you. It helps to know what is normal and what may not be, as well as what routine tests and care may be advised by your health care provider.

The changes that began in the first weeks of pregnancy increase and accelerate during the second trimester. During the second trimester, your growing uterus is the most obvious change. In addition, more blood is produced to supply the placenta with oxygen and nutrients for your baby's growth. Your digestive system slows the rate at which food moves through your system. Every organ system in your body continues to adapt to pregnancy, influenced by increasing hormone levels. These and other changes may produce specific signs and symptoms.

Aches and Pains
By the end of 27 weeks, the fetus will be about four times bigger than it was at 12 weeks. As the uterus becomes too big to fit within your pelvis, internal organs are pushed out of their usual places, and greater tension is placed on surrounding muscles and ligaments. All of this growth is likely to result in some discomfort. The common aches and pains of the second trimester mostly stem from the increase in the size and weight of the uterus, as well as from the effects of pregnancy's hormones.

Back pain
During pregnancy, the joints between your pelvic bones begin to soften and loosen in preparation for the baby to pass through your pelvis during birth. In the second trimester, your uterus becomes heavier, changing your center of gravity. Gradually -- and perhaps without even noticing it -- you will begin to adjust your posture and the ways in which you move. Compensations you make for the change in your center of gravity can result in back pain, strain or other injury.

Another contributor to back pain may be separation (diastasis) of the muscles along the front of the abdomen (the rectus abdominis muscles). These two parallel sheets of muscles run from the rib cage to the pubic bone. As the uterus expands, these muscles sometimes separate along the center seam, and back pain can then become worse. Your doctor can evaluate whether the amount of separation is more than usual and may suggest ways to remedy the separation after your baby is born.

To prevent or ease back pain:

  1. Be aware of how you stand, sit and move. Practice correct posture. Stand with your pelvis tucked in and your shoulders back. When standing for long periods, rest one foot on a low step stool if possible. Sit with your feet slightly elevated, and don't cross your legs. If you must sit for long periods, take breaks at least every half hour.

  2. Lift correctly: Place your feet one shoulder's width apart; lower your body by bending at the knees, not the waist; and lift by pushing up with your thighs, not with your back.

  3. When sleeping or resting, lie on your side, with your knees and hips bent. Place a pillow between your knees and another one under your abdomen. This position will take the pressure off your lower back.

  4. Exercise to strengthen the muscles in your abdomen - this will help minimize back pain.

If none of these measures bring relief, your doctor may recommend special back strengthening exercises or classes for pregnant women.

Abdominal pain
Pain in the lower abdomen during the second trimester is often related to the stretching of ligaments and muscles around the expanding uterus. Although this cause of abdominal pain does not pose a threat to you or your baby, it is important to report it to your doctor because abdominal pain may be a symptom of other problems.

A fairly common cause of abdominal or groin pain in mid-pregnancy is stretching or spasming of the round ligament. The round ligament is a cord-like structure made of muscle that attaches to the uterus, though it does little to support it. Before pregnancy, the round ligament is less than a quarter of an inch thick. By the end of pregnancy, it has become longer, thicker and more taut. A sudden movement or reach can stretch the round ligament. This may cause a pulling or stabbing pang in your lower pelvic area or groin, or a sharp cramp down your side. The discomfort usually lasts several seconds to minutes and then goes away.

If you've had abdominal surgery, especially on the tubes and ovaries, you may have pain from the pulling or stretching of adhesions. These are bands of scar tissue that adhere to other structures, such as the walls of the abdomen. The increasing size of the uterus can cause these bands of tissue to stretch or even to pull apart, which can be painful. Sometimes pain from an inflamed appendix or gallbladder can appear in unusual locations during pregnancy. This pain develops because the organs inside the abdominal area are crowded out of their usual positions by the growing uterus. A non-pregnant woman would probably feel pain from appendicitis in the lower right side of her pelvis, but a woman in the second trimester of pregnancy is more likely to feel this pain higher up in the abdomen.

It may help to sit or lie down when abdominal pain becomes bothersome. Relaxation exercises may help, as may soaking in a warm bath. The relatively minor aches and pains described here will usually diminish as your pregnancy progresses. If the pain is severe, however, call your doctor immediately.

Leg cramps
Cramps in the lower leg muscles are fairly common in the second and third trimesters. They often occur at night and may disrupt your sleep. The exact cause of leg cramps is uncertain, but they may be due to an inadequate amount of calcium in your diet, fatigue, or pressure of the uterus on nerves in your legs.

If you are suffering from leg cramps, try doing exercises to stretch your calf muscles. Other measures to ease or prevent leg cramps include wearing support hose, especially if you stand a lot during the day. Take frequent breaks from sitting or standing for long periods. If you do get a cramp, you might be able to relieve it by straightening your knee and gently flexing your foot upward. Applying local heat may also help. If leg cramps persist, are severe, or are associated with leg swelling, tell your doctor about the problem. In rare cases, they may indicate that a blood clot has formed in a vein, which would require medical treatment.

Heartburn
Heartburn actually has nothing to do with your heart. It is caused by the contents of the stomach backing up into the esophagus (the tube that carries food from the mouth to the stomach). When this occurs, stomach acids irritate the lining of the esophagus. The resulting burning sensation at about the level of the heart gives this condition its misleading name.

There are many reasons why heartburn is more common during pregnancy. One reason is that your growing uterus is continually pushing on your stomach, moving it higher and higher up in your abdomen and compressing it. This helps push the stomach contents back into the esophagus. Another reason is that your digestive system as a whole, under the influence of hormones, has slowed down. The wavelike movements of the esophagus that push swallowed food down into your stomach tend to become slower during pregnancy. In addition, the one-way valve at the end of the esophagus that keeps food and acid from backing up becomes ineffective under the influence of the hormones of pregnancy. This allows food to back up into the esophagus. Your stomach also takes longer to empty, and food moves more slowly along your gastrointestinal tract. The purpose of this general slowdown is to allow nutrients more time to be absorbed into your bloodstream and to reach the fetus. Unfortunately, this can also cause bloating and indigestion.

Some of the things that ease nausea and vomiting during the first trimester may also help your heartburn during the second trimester. For example:

  1. Eat frequent and small meals that do not overfill your stomach.

  2. Avoid movements and positions that seem to aggravate the problem. When picking things up, bend at your knees, not your waist.

  3. Avoid lying flat on your back when resting or sleeping. Instead, prop yourself up on pillows.

If heartburn is irritating enough to keep you from eating properly, your doctor may prescribe an antacid. Do not take any antacid without talking to your doctor first. Some antacids contain sodium, which can cause fluid buildup in body tissues during pregnancy. Rarely, an inflammation of the esophagus may cause heartburn. When this is suspected, a procedure (endoscopy) can be done to view the inside of the esophagus. The condition can be treated with medication during pregnancy.

Skin Changes (Darkening)
The hormones at work in your body during pregnancy can cause several changes in your skin. One of the most common, occurring in 90 percent of all pregnant women, is skin darkening. This symptom is more pronounced in dark-skinned women. Its exact cause is unknown, but it may be related to increased levels of estrogen. Skin darkening during pregnancy is typically noticeable on or around the nipples, in the area between the vulva and the anus (the perineum) and around the navel. You may also notice it on your armpits and inner thighs. The pale line that runs from the navel to the pubic bone, called the linea alba (white line), often darkens during pregnancy, and is referred to as the linea nigra (black line). In some pregnant women, mild skin darkening on the face also develops. This is commonly called the "mask of pregnancy" or chloasma.

Skin darkening during pregnancy is made worse by exposure to sunlight or to other sources of ultraviolet (UV) light. If you have this problem, avoid getting too much sun. Always wear sunblock with a skin protection factor (SPF) of at least 15 when outdoors. Whether it's sunny or cloudy, the sun's UV rays reach your skin. A wide-brimmed hat that shades your face will also help reduce exposure to the sun's UV rays. Skin darkening may fade after delivery, but not always completely. If it is extreme, especially on your face, covering make up may help. Avoid agents that bleach the skin. If yours is a severe case, it might be improved with a medicated ointment that can be prescribed by your doctor.

Other skin symptoms
Below are other common skin changes that usually disappear after delivery:

  1. Red and itchy palms and soles may appear after delivery and can be relieved by using moisturizing creams.
  2. Blotchy patches on your legs and feet may appear at times, particularly when you are chilly. They do not signal a problem or cause discomfort.
  3. Skin tags are small, loose growths of skin that may appear under your arms or breasts. They usually disappear after birth but can be easily removed if they don't.
  4. Moles may become more numerous, but the ones that appear during pregnancy are usually not the types that are linked to skin cancer. Just to be sure, though, it is still a good idea to show any new moles to your doctor.
  5. Brittle and soft fingernails. Using nail polish may make them worse. Moisturize your nails as well as your hands with lotion, and wear rubber gloves when working with detergents or cleansers.
  6. Heat rash can be soothed by applying cornstarch after bathing, avoiding very hot baths or showers and keeping the skin cool and dry.

Constipation
Unfortunately, constipation is one of the most common and uncomfortable side effects of pregnancy. It is due to the general slowdown in the digestive system and to the pressure of the uterus on the lower bowel. Constipation also tends to give rise to hemorrhoids later in pregnancy.

To ease constipation, try the following:

  1. Evaluate your diet. Foods high in fiber will help prevent or ease constipation, as will drinking plenty of fluids. Fruits, vegetables and whole-grain foods may provide the fiber you need. Fruit juices, particularly the age-old remedy of prune juice, can also be effective.
  2. Increase the amount you exercise. Just adding a little time to your daily walks or other exercise regimen can help.

If these measures fail, your doctor may recommend a mild laxative such as milk of magnesia, a bulking agent or a stool softener. But take these remedies only on the advice of your health care provider. Don't take cod liver oil during pregnancy because it can interfere with the absorption of certain vitamins and nutrients. Also avoid other harsh laxatives and enemas.

Weight Gain
How much weight will you gain during the second trimester? The answer varies somewhat depending on your weight before pregnancy, but you'll probably gain about a pound a week after the first trimester. It is typical to fluctuate somewhat, perhaps gaining a pound and a half one week and only half a pound the next. There is no need to worry as long as your weight gain is steady, without any sudden increases or decreases.

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Last Reviewed: Mar 03, 2006

Thomas  A deHoop, MD Thomas A deHoop, MD
Formerly Associate Professor of Clinical Obstetrics and Gynecology
Director, Medical Student Education
No longer associated

Arthur T Ollendorff, MD Arthur T Ollendorff, MD
Associate Professor of Obstetrics and Gynecology
College of Medicine
University of Cincinnati