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Second Trimester

The second trimester is from 14 to 26 weeks.  It is often considered the easiest trimester.  Most women state they feel better physically during this trimester.

Prenatal visits

During this trimester we will be seeing you every four weeks until 24-28 weeks.  Once you have your glucose screening test you will be seen every two weeks.  These visits are typically brief and involve having your blood pressure taken as well as leaving a urine sample.  We will be checking your urine for protein and glucose as well as you will be weighed so that we can monitor your weight gain throughout the pregnancy. 

Fundal height

Your fundal height is a way to monitor the growth of your fetus.  We will measure the size of the uterus in centimeters and this should approximately equal the number of weeks in the pregnancy plus or minus three centimeters.  We will measure from the upper end of your pubic bone to the top portion of the uterus. For example, let's say that you just reached the 24th week of pregnancy; your fundal height can range anywhere from 22 cm to 26 cm.  If for some reason we note a measurement outside of this range, we will alert you to further testing if needed.  Monitoring fetal growth may also be done with additional ultrasounds if necessary.

Screening

If you opted to have the first trimester screening we will offer you the alpha- fetoprotein test. If you have not had the first trimester screening, a quad screen may be available to you.  This is an optional genetic screening test.  The alpha-fetoprotein test is a screening for spina bifida and other neural tube defects.  If a screening test is positive you may need further confirmatory testing.

Reasons that your test could be abnormal:  If you are carrying twins or you are farther in your pregnancy than we thought, this test could be abnormal.  Also, if there are mild placental abnormalities which would place your pregnancy at risk for preterm labor, preeclampsia or a small birth weight baby,  an abnormal test result can occur.  

The definitive test for neural tube defects is an amniocentesis.  

Anatomy scan

One of the most common questions we are asked is, “When will I find out if I am having a boy or a girl?”  An anatomy scan is typically offered at 18-20 weeks.   The anatomy scan is also considered a screening test because it allows us to screen for most anatomic abnormalities.    The anatomy scan will also confirm your due date, the number of fetuses, the overall growth and development and the placental location.  A normal ultrasound is very reassuring but does not eliminate the possibility of birth defects. 

We offer the anatomy scan here in the office.  If your pregnancy is considered high-risk we will refer you to the Maternal Fetal Medicine Women's Health Center at St. Agnes Hospital to have your anatomy scan and additional consultation as needed.  If your insurance does not permit ultrasounds to be done in our office, you will be referred to a radiologist for this exam.

There are times that your ultrasound cannot be completed at your initial appointment.  You may be asked to schedule a follow up visit if your anatomy scan is not completed.

Glucose Tolerance Testing

From 24-28 weeks of pregnancy we recommend a screening test for diabetes.  You will be asked to come in to the office and drink a 50 gram one hour glucose tolerance test.  You will drink this in the office and blood work will be done one hour afterwards.  We will give you instructions for prior to your exam when you schedule your glucose tolerance test. 

Nutrition

It is important that you remember that you should be adhering to a well balanced diet.  If you develop gestational diabetes you will be referred to Maternal Fetal Medicine for diabetic teaching and further testing.  We will discuss this further as needed.     

Weight gain

If we advised you that you are underweight (a BMI <18.5), you should strive to gain no more than 1 pound/week

If your BMI is between 18.5 - 24.9 you should also strive to gain no more than 1 pound/week.

If you were told you are overweight or your BMI >25  or you are obese (BMI > 30), you should gain no more than 0.5 pound/week.

If you find that you are gaining an excessive amount of weight, make sure that you are incorporating cardiovascular activity into your daily routine.  You should be striving to exercise at least three times a week for 30 minutes at a time.  Suggested exercise include walking, elliptical or the treadmill.  If you were previously taking an exercise class, please inform your instructor that you are pregnant.  If you have any questions on the appropriate exercises, please let us know at your appointment.
 

Vaccinations 

If we are in flu season and you have not yet received the flu shot we will recommend you have the flu shot in the office.  We will also recommend that you have your tdap vaccination.  Optimal timing for tdap vaccination is from the 27th week to the 36th week.  Family and friends should also be recommended to have the vaccination.  Ideally the vaccination should be administered 2 weeks prior to exposure to the infant.  Tdap is used to minimize the infant’s likelihood of developing pertussis or the "whooping cough." 

Goals 

Registering at the hospital:

Register for your delivery at Saint Agnes Hospital.  Ensure that you have sent in a Pre-Admission form to the hospital.     

Select a pediatrician.  Make sure to refer to the provider list provided by your insurance.  Consider a tour of the office you select. 

Prenatal Classes and Hospital Tour

Consider prenatal classes.  You will need to call Saint Agnes to schedule your childbirth classes or visit the Saint Agnes website for information on prenatal education classes. 

  For dates, times, cost and to register call 1-866-690-WELL (9355). 

  • 4- Week Weekday Childbirth Education with Tour ($90) 2-hour course held one weekday per week for 4 weeks
  • 2-Week Childbirth Education with Tour ($90) 2-hour course held two days per week for 2 weeks
  • Half-Day Childbirth Education Package with Tour ($90) 4-hour course held either Saturday OR Sunday for 2 weeks
  • Weekend Childbirth Education Package with Tour ($140) Includes Infant Care and CPR
  • 1-Day Intensive Childbirth Class with Tour ($90)
  • Refresher Childbirth Class with Tour ($25) For those who have attended a childbirth class in the past
  • Cesarean Birth Class with Tour ($20) For those told a cesarean birth may be needed
  • Bed Rest Childbirth Kit ($50) Receive a $25 refund when the kit is returned

There are also regularly scheduled tours of Saint Agnes’ birthing center. Tours are offered in both English and Spanish.  

Additional considerations:  

Cord blood banking

Cord blood banking -  There are public and private cord blood banking options.  If you are interested in learning more you should know that there are several companies available.  If you would like to learn more about the benefits and limitations of cord blood donation and transplants you may want to visit the http://bethematch.org/ and select "Give birth to hope by donating your baby's cord blood."  We will also be happy to review any questions you may have to help you and your family make the decision about cord blood banking.

Travel

We typically ask you to restrict travel during pregnancy.  If you have to schedule travel during pregnancy we ask that you schedule your travel between 14 and 28 weeks.   If you are planning a long car trip say to Florida we advise that you limit your daily driving to six hours.  We also ask that you make frequent stops and ambulate for at least 30 minutes every 90 minutes.  Ensure that you are wearing your seat belt throughout your trip.   You may also want to consider wearing compression stockings during your trip.  You will need to stay well hydrated.  

If you are planning air travel we recommend that you ambulate in flight every 45 minutes to an hour.  Remember to wear your seat belt throughout your flight.  You will want to avoid carbonated beverages and ensure that you stay well hydrated.  Most airlines will not permit air travel after 36 weeks.

If you are planning a cruise remember to travel with your prenatal records.  You may want to postpone your cruise until after pregnancy.  If you are unable to make sure that you research your cruise line's policies and prior history.  Ensure that you are adhering to good hand washing practices.  

Concerns in the Second Trimester 

Fetal movement 

     Flutter is typically felt as early as 16 weeks.  We expect that you will start to feel fetal movements from 17 to 20 weeks.  Depending on the location of the placenta, which will be confirmed at your anatomy ultrasound, you may not feel movements until after 20 weeks.  At first, patients typically describe the movements as muscle twitches or gas rumbling as the fetus continues to grow you will actually start to feel "kicks."  Fetal kick counts are typically advised at 32 weeks and beyond.  We ask that you monitor movements and ensure that you are feeling at least 10 fetal movements in a two hour time frame while you are at rest in a quiet room and focused on monitoring movements.  If you are experiencing decreased fetal movement we ask that you contact the office for further instructions.   

Antenatal testing 

If you have been told your pregnancy is high risk, you have a pre-existing medical condition such as diabetes or hypertension, or you have gestational diabetes, gestational hypertension or preeclampsia we may ask that you undergo antenatal testing.  A non stress test may be required.  We will schedule an appointment to monitor fetal heart rate as well as contraction pattern. This may be done along with a biophysical profile, which is an ultrasound evaluation of fetal movements as well as amniotic fluid, among other factors.  Antenatal testing may be done in the office or we may have you schedule testing at the Women's Health Center at Saint Agnes. 

Round Ligament Pain 

     Around 16-20 weeks you may begin to notice sharp stabbing pains in your groin.  The pain can be either right or left sided.  These pains typically do not indicate any problems.  The round ligaments are ligaments that hold the uterus in place and you may notice that as the uterus continues to grow the continuous stretching may cause occasional spasms.  Typically compresses to the area as well as stretching exercises such as prenatal yoga or Pilates may help with this pain.  Acetaminophen may also provide pain relief. 

Signs of preterm labor

We will ask you about whether you are feeling contractions, increase in discharge or any leaking of fluid, any vaginal bleeding and about fetal movement at each visit.  If you notice you are having Braxton Hick contractions, this may not be a sign of labor.  True contractions typically increase in frequency over time and are associated with pain while Braxton Hicks contractions are typically painless contractions.  If you are having any of the above, we ask that you call the office to come in for an evaluation.