What to Expect During the Second Trimester of Pregnancy

One of pregnancy’s most important times is the second trimester, between 14 and 27 weeks. It includes rapid development of the baby, vital tests and the 20-week ultrasound.

“It’s an exciting time in pregnancy and it zooms by fast,” said Trevor Watson, MD, an OB specialist with Avera Medical Group Obstetrics & Gynecology in Aberdeen. “It marks the beginning of fetal movement and other benchmarks important in development of the child.”

Common Tests and Steps for Pregnancy Health

Prenatal visits occur about every four weeks for moms-to-be, up to 28 weeks, when they are scheduled more often. Patients will take part in several tests, such as:

• Rhesus (Rh) factor: Moms have their blood type tested during the first trimester. In some cases, moms will receive a prescription called RhoGAM^®. Your provider will explain how blood types, both for mom and baby, are important.
• Gestational diabetes: Blood tests measure your blood sugar. If it is too high, a second test takes place. This condition occurs in about 10% or less of all births. If you have it, you’ll need to watch your blood sugar and manage the condition with diet, exercise and possibly oral medications or insulin injections.
• Preeclampsia: Providers pay close attention to blood pressure, especially after 28 weeks, and also watch for protein in the urine. Preeclampsia can be managed, yet if it goes unchecked, it can affect the mother’s kidney and liver function. If the condition is severe, early delivery may be necessary for the mother’s well-being. Signs that this condition might occur include headaches, stomach pain and changes in vision.

“Many patients also will get vaccinations, such as Tdap, to boost their immunity and pass it on to baby,” Watson added.

The First Ultrasound, Boy or Girl and More

The most cinematic of moments in pregnancy often comes during the 20-week ultrasound appointment, when a technician will listen to the fetal heartbeat, and measure for uterine and belly length and growth.

Watson said you can learn the baby’s gender right away, get an envelope or ask to not learn it.

“The exam includes review of many developments in the fetus, yet every mom and dad is different and your decision on knowing if it is a girl or boy is just that – your decision,” Watson said.

Second Trimester Symptoms – Both Good and Bad

The good news is that morning sickness is over for most pregnant women by 12 weeks. But a new round of symptoms can appear during the second trimester:

• Your baby bump will become more visible starting around 16 weeks
• General aches and pains, including pelvic pain
• Lower back and abdominal pain
• Gastrointestinal issues, such as reflux
• Fatigue
• Skin changes, such as pigmentation, acne breakouts, dryness or itchiness
• Skin rashes (report to provider)

“Staying active can help. Weight gain is normal, but not too much,” said Watson. “More weight gain occurs in the third trimester. You’ll feel some normal fatigue, and reflux will increase as you get closer to delivery.”

Feeling Baby’s First Movement

The movement of the baby usually begins around the 20-week mark and is often described as “fluttering or butterflies” in the abdominal area. Some kicks from the fetus will begin at this point in the journey, too.

“The American College of Obstetricians and Gynecologists says about 10 movements during a two-hour period is normal during this trimester,” Watson said. “But sometimes you may be busy, or exercising and you might not feel them.”

Watson said the true expert on fetal movement is mom herself; there should be some, but being too worried about counting the movements isn’t necessary and can be detrimental for your mental and emotional state. As baby grows bigger, movements are more noticeable.

If you think you’re noticing fewer movements than normal, stop what you’re doing, rest, and concentrate on your baby. “Call your doctor and get monitored if you think the movement is too little,” he said.

When to Call Your Doctor

Any situations like these warrant a call to your OB provider without delay:

• Fever
• No fetal movement
• Watery discharge or vaginal bleeding
• Contraction-like cramps or pain, especially that keep happening
• Severe pain or headache, along with blurry or abnormal vision

“Err on the side of caution and call us,” Watson said. “Each pregnancy is different, but it’s better to get reassurance and know everything is fine than to miss something.”

Early Births

While your provider will work with you to prevent a premature delivery during the second trimester, if at all possible, it’s good to be aware of the facts:

• Fetal viability is usually considered to be at 22-23 weeks. The baby can survive but will likely have significant health problems.
• Babies born prematurely after 28 weeks will spend significant time in a neonatal intensive care unit (NICU).
• Premature babies born at 36 weeks or later usually can grow and recover at a hospital close to home.

“Avera’s NICU is in Sioux Falls, and early births will benefit most from time in that specialized environment,” Watson said.

Education and More Information

At the 20-week mark, parents are encouraged to make their plans and get information or sign up for classes on a number of topics, from breastfeeding, to pain control and how to make a formal birth plan. Keep reading for more resources:

• Planning for pregnancy
• I'm pregnant, now what?
• Avera's pregnancy services