Second Trimester

June 26, 2017

The second trimester of pregnancy is generally the most comfortable of the three trimesters. Time seems to fly by. The uterus grows to several inches above the umbilicus. The baby grows considerably during this time and by the 28th week is approximately 16 inches long and weighs two and a half to three pounds.

The movements of the baby become stronger and you can feel kicking. With first pregnancies, these movements are usually not noticed until approximately 18–20 weeks, but with subsequent pregnancies, they are usually felt two to four weeks earlier.

Another landmark event of the second trimester is that the baby’s heartbeat can be detected with a special stethoscope. The baby’s heart tones are heard at approximately 18–20 weeks gestation and can confirm your estimated due date. At 20 weeks the uterus measurement corresponds to the number of weeks gestation of pregnancy (called the McDonald’s measurement). If the measurement is greater or smaller than the dates, this may require some additional evaluation such as an ultrasound.

The growing uterus pressing on the bowels, along with the rising level of hormones, causes the intestines to empty more slowly. In addition, it causes a relaxation of the muscle at the top of the stomach, which keeps food in the stomach. This may result in heartburn, increased bowel gas, and constipation.

A hormone from the pituitary gland, MSH (Melanocyte Stimulating Hormone), causes pigment-containing cells in your skin to increase. This causes a dark line to develop from the navel to the pubis, called the linea nigra. This usually fades after delivery, but it may remain visible. The nipples of the breasts also darken. Some women may also develop dark blotches on the face, often referred to as the mask of pregnancy or chloasma.

Another skin change is the development of stretch marks. These occur when the skin is stretched until its connective tissues break; they appear as red or pink streaks on the abdomen, thighs, and breasts. The marks will fade to white after delivery, but they may remain visible. Although heredity is the major cause of stretch marks, you may be able to prevent some stretch marks by massaging the skin with a lotion containing lanolin or cocoa butter.

The circulatory system undergoes some profound changes during pregnancy. Your blood volume increases by approximately 50% to accommodate the growing uterus and fetus. This increased blood volume results in a greater awareness of your beating heart, referred to as palpitations.
Another effect is engorgement of the blood vessels in the mucous membranes of the nose and sinuses, causing nasal congestion and pressure around the sinuses.

A general increase in the amount of fluid in the body causes swelling of the cells that cover the eyes. This may result in a slight blurring of vision, and it may become uncomfortable to wear contact lenses. It is generally best to not change your prescription for corrective lenses or purchase contact lenses during pregnancy.

By the end of the 28th week of pregnancy, you should have gained approximately 13–15 pounds. Weight gain from this time on should be approximately three quarters of a pound per week.
During the second trimester, one’s feelings generally involve an acceptance of being pregnant. Awareness of the baby makes the pregnancy more real. In addition, women often feel concerned about changes in their appearance, since this is when the pregnancy begins to show.
Generally, women feel comfortable, satisfied, and creative during this time. Dreaming during sleep becomes more frequent, and the dreams often seem very real.

Food cravings for specific foods or unusual food combinations are common during pregnancy. If you crave pickles and ice cream, you are not weird—just pregnant. These cravings, however, should not be allowed to interfere with the good nutrition that your growing baby requires.

Heartburn occurs when the uterus presses on the stomach, and the muscle at the top of the stomach relaxes, causing regurgitation of the stomach contents into the esophagus. Indigestion and heartburn may result. Symptoms are often worse at night and whenever you lie down, so it may help to sleep in a semi-reclining position. Use pillows or place three- or four-inch blocks beneath the head of the bed to elevate it.

Avoid overfilling the stomach by having several small meals each day rather than one or two large ones. Also, avoid a large intake of fluids in the evening just prior to bedtime.
If these methods fail to improve your symptoms, you may need liquid antacid medications. You can obtain Gaviscon, Riopan, Mylanta, or Maalox without prescription. Mylicon tablets may also help reduce excess gas. You can also drink warm spearmint tea (tea leaves & spearmint leaves, no herbs)

Increased bowel gas is a distressing symptom that has no easy solution. In addition to being embarrassing, it may cause intermittent abdominal pains that last anywhere from a few minutes to a few hours. The pains are usually relieved when the bubble of gas breaks up and begins to move away from the spot where it was trapped, on through the intestine. Avoid gas-forming foods such as beans, cabbage, cauliflower, broccoli, and very spicy foods.

Constipation is a common symptom in pregnancy. It can be relieved by drinking ten glasses of water and other fluids each day, exercising regularly, and increasing the fiber content of your diet. If these changes are not effective, you may require a non-prescription stool softener such as Colace, Surfax, Metamucil, or Perdiem. Konsyl is an all natural fever therapy. If all of these methods fail, you may occasionally use a mild laxative such as Milk of Magnesia.

The round ligaments extend from the top of each side of the uterus to the groin. Certain movements may cause the uterus to shift, which stretches these ligaments and causes sharp, intense pain along one or both sides. These pains are referred to as round ligament pains. The pain usually lasts only a few seconds and can be relieved by changing positions to reduce stretching and straining the ligament. You can usually avoid this pain by slowly shifting positions.

Leg cramps, or spasms in the calf muscles, may occur during pregnancy. Wearing good, supportive stockings can help to eliminate these cramps. It may also be helpful to take more calcium and lower the phosphates in your diet. If cramps occur, you should gently pull your foot upward to stretch the muscle in the back of your leg.

Nosebleeds may occur due to enlarged blood vessels in the nasal membranes. By humidifying the air in your home, you may be able to prevent nosebleeds. Running a vaporizer by your bedside throughout the night—preferably one that produces a cool mist—may help.

If a nosebleed occurs, simply pinch your nose for seven or eight minutes to stop the bleeding and to allow a blood clot to form. If this fails to stop the bleeding, please notify us so that we can help.

Bleeding gums are common in pregnancy due to enlarged blood vessels in the gums. You can prevent this by careful and frequent brushing and flossing. More vitamin C may also help.

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