Second Trimester of pregnancy-Medcall(Kannada) Care Plan
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Pregnancy and Importance of Health Care: Taking care of a woman when she is pregnant till she gives birth to a baby is called the prenatal care. The total duration of pregnancy is 40 weeks and it starts from day 1 of your previous menstrual cycle. A normal pregnancy comprises of 3 trimesters where the first trimester starts from the time your baby is conceived and runs through week 14 of your pregnancy.
The second trimester of your pregnancy starts from week 14 and goes through week 28. Your doctor might speak to you in terms of weeks rather than months.
In your second trimester, you will have a prenatal visit every month. These visits are usually quick and are very important. During your visits, your doctor will do a physical examination; you will have to get an ultrasound and some laboratory tests done. You can also discuss with your doctor if you have any concerns or issues. Physical examination: During this visit your doctor will check your weight, blood pressure and your overall health status. By about 20 weeks you will be able to feel the movements of your baby. Inform this to your doctor during the visit.
Laboratory tests: Blood tests will be done to check your
Hemoglobin: This measures the amount of red blood cells in your blood.
Glucose tolerance test (GTT): This checks for signs of diabetes that may begin during pregnancy called the Gestational diabetes. In this test, your doctor will give you a sweet liquid. An hour later, your blood will be drawn to check your blood sugar levels. If your results are not normal, you will have a longer glucose tolerance test.
Antibody screening - This test will be required if your blood group is Rh negative.
Urine analysis for signs of bladder, urinary tract or kidney infection. Also urine sugar and protein analysis will be done to rule out Gestational diabetes.
Blood tests might be done to screen for developmental or chromosomal conditions, such as spina bifida or Down syndrome.
Ultrasound: This scan is more commonly called as the anomaly scan, which is done at around 20 weeks of pregnancy. Any congenital anomalies can most probably be detected during this scan and further treatment options can be decided.
Genetic testing: Quadruple screen test is a blood test done during pregnancy to determine whether the baby is at risk for certain birth defects which includes measuring of four pregnancy hormones- Alpha-fetoprotein (AFP), Human chorionic gonadotropin (hCG), Unconjugated estriol (uE3) and Inhibin A. If Inhibin A is not include then the test is called triple screen test. The quadruple screen test is normally done between the 15th and 22nd week of pregnancy if you are at greater risk for having a baby with these defects like if you are over 35 years old during pregnancy, if you are taking insulin to treat diabetes, and you have a family history of birth defects.
If the tests are normal then nothing more has to be done but if the tests are abnormal then you will have to undergo further investigations like ultrasound and amniocentesis.(3)
The goals of prenatal care are to:
Monitor both the mother and baby throughout the pregnancy
Look for changes that may lead to a high-risk pregnancy
To know nutritional requirements during and after pregnancy
To know activity recommendations or restrictions
Discuss common pregnancy complaints such as morning sickness, backaches, leg pain, frequent urination, constipation, and heartburn and how to manage them, preferably without medications
Give support to the pregnant woman and her family.(4)
This template will help you understand few of these aspects. Consult your doctor for same.
Symptoms and signs during second trimester of pregnancy
Some of the common changes seen during second trimester are: 1.Larger breasts: The milk-producing glands inside your breasts get larger during the second trimester due to the effect of estrogen and progesterone. Additional fat also might accumulate in your breasts. Although some of the initial breast tenderness will likely improve, nipple tenderness might continue throughout the pregnancy. A supportive bra is always better to be used. 2. Growing belly:As your uterus becomes heavier and expands to make room for the baby, your abdomen also expands sometimes rapidly.
3. Quickening:The first delicate flutter of movement in your abdomen, which is the movement of your baby in the womb is called quickening. This usually happens between 16-20 weeks. Then on you start feeling it regularly 4. Braxton Hicks contractions:Your uterus might start contracting to build strength for the big job ahead. These warm-ups called Braxton Hicks contractions are felt in your lower abdomen and groin. They are usually weak and come and go unpredictably. 5.Skin changes:The pigment-bearing cells in your skin increases, as a result of which you might notice dark spots on your breasts or inner thighs. You might also see a faint, dark line down your abdomen called linea nigra. Dark patches might appear on your face as well called melasma. Sun exposure can aggravate the issue. 6. Stretch marks:Pink, red or purple streaks appear along your abdomen, breasts, upper arms, buttocks or thighs during the second trimester of pregnancy. Stretching might also be associated with itching. These stretch marks cannot be prevented but they eventually fade in intensity. 7. Nasal and gum problems:As pregnancy increases your circulation, the lining of your nose and airway swell, which restrict airflow and lead to snoring, congestion and nosebleeds. Increased blood circulation can also soften your gums, which might cause minor bleeding when you brush or floss your teeth. Switching to a softer toothbrush can help decrease irritation. 8.Dizziness: Your blood vessels dilate in response to pregnancy hormones. Until your blood volume expands to fill them, your blood pressure will fall and you might experience occasional dizziness. 9. Leg cramps:You may have leg cramps often striking at night. To help prevent leg cramps, stretch your calf muscles before bed. A hot shower, warm bath or ice massage also may help. 10.Shortness of breath:Your lungs are processing more air than they did before your pregnancy. This allows your blood to carry more oxygen to your placenta and the baby - and might leave you breathing slightly faster and feeling short of breath. 11.Vaginal discharge:A thin, white vaginal discharge during pregnancy is thought to help suppress the growth of potentially harmful bacteria or yeast. 12.Bladder and kidney infections:Hormonal changes slow the flow of urine, and your expanding uterus might get in the way - both factors increase the risk of bladder and kidney infections.. Contact your doctor if you notice an discharge from below. (7),(8)
Care of breast and nipple during pregnancy As breast and nipple undergo continuous change throughout the pregnancy, taking care of them forms an important part of prenatal care. Some of the tips are-
Make sure you wear a right sized bra, so that you do not develop stretch marks. Since the size of breast continue to increase take care to change the bra accordingly.
Avoid wearing under-wired bras, as they might hamper the functioning of the milk glands. Never wear a very tight bra.
The nipple might become too rough and might develop cracks. Lightly massage your nipples with coconut oil to reduce this problem.
Sometimes you may develop inverted nipples. So gently pull out the nipples, so that by the time the child is born the nipples are in correct position. This is one of the important breast care tip that has to be followed during pregnancy.(17)
Vaginal discharge strong smelling, green or yellowish associated with itching
Pain and burning during micturition
Leg or calf pain, or swelling or one sided/severe headache
Headache that does not go away with medication.
Loss of vision
Flare-up of chronic pre-existing conditions like high blood pressure, diabetes, thyroid diseases, lupus etc.(6),(9)
Injury: Be safe during pregnancy because you are more susceptible to injury as your center of gravity has changed with pregnancy, which means it's easier to lose your balance and harder to see your feet. While driving a car, fasten your seatbelt and tilt the steering wheel at least 10 inches away from your chest. Be careful in the bathroom, and add nonskid surfaces to your shower if you don't have them. Check your house for other hazards that could cause you to fall.
Schedule for Consultations/Diagnostic tests: During the second trimester you will have to visit your doctor every month and sooner if you have any problems. Continue the iron tablet to maintain the red blood cell counts. You will be now prescribed calcium supplements to be taken throughout your pregnancy.
During the second trimester, you will also receive 2 doses of tetanus toxoid injection whatever may your immunization status be before. The first dose will usually be given at around 20 weeks of pregnancy. The second dose is given 6-8 weeks after the first dose.
It is safe to exercise daily during the second trimester. If you are comfortable you can manage 30 minutes of moderate physical activity (such as walking or swimming) three to seven days each week without difficulty. Depending on how much you exercise, you will also have to increase your daily calories accordingly. You should always warm up before you exercise and slow down your pace before you come to a complete stop.
Month-by-month guidelines for exercise during the second trimester are:
4th Month 1. Weight training: As you begin your second trimester, you may feel dizzy or light headed if you stand for long period due to pooling of the blood. For this reason it may be safer to do weight training exercises while seated. Always keep your breath steady during weight training to avoid straining your muscles and blood vessels.
2. Jogging and running: You can safely continue to run in moderation. Due to shift in the centre of gravity you are more likely to lose your balance. Hence run on flat ground with as few obstacles as possible. 3. Yoga: Pay attention to your body and only do as much exercise as is comfortable. Your breathing should stay smooth, and if you find you cannot breathe easily and smoothly during positions, think about shifting into an easier version of the position, stretching or extending less or staying closer to the floor. 4. Swimming and Water Aerobics: If you are a swimmer, you should be able to continue swimming into your second trimester without any difficulty. If you are new to swimming, start slowly by swimming gently for short periods of time, taking caution not to overexert yourself. Work up to longer workouts if you desire. Moderate water aerobics may also be helpful for previously inactive women. This activity may even reduce your desire for analgesia during labor.
5th Month When you reach 20 weeks, you should stop exercises that require you to lie on your back (like some weight lifting or yoga poses).
Walking: As your gait changes because of the changes in your body shape, be sure to focus on your posture when walking.
Yoga: As your pregnancy progresses and has a larger impact on your activity, think about joining a yoga class specifically for pregnant women or buying a book or video of yoga poses that are safe for pregnant women.
Swimming : If you are a swimmer, you should be able to continue swimming into your second trimester without any difficulty. If you begin to get short of breath during swims, try slowing your pace and staying near the edge or shallow end of the pool.
6th Month Don't push yourself too hard. Keep yourself hydrated by drinking a glass of water before, during, and after exercise and cool.
Weight training: You may want to decrease the duration or frequency of your workout, depending on how you're feeling. You may also be more comfortable with lighter weights. If you use free weights, be very careful to avoid blunt injury to the abdomen from dropping weights. Do not hold your breath during repetitions, and do not lie on your back.
Yoga: Now that you're at the end of your second trimester, you may need extra balance support when doing standing poses. Avoid poses that stretch the abdominal muscles or that require you to lie on your back. Bend from your hips. If you feel discomfort, stop and re-evaluate if there's an easier way to do the position.
Try the following activities to break a sweat during the second trimester:
Stationary bicycling (recumbent if needed)
Rowing (in a canoe or on the machine at the gym)
Housework (sweeping, vacuuming, gardening, window-washing, and even mowing the lawn)
Sex (avoid lying on your back) (Mayo Clinic, 2012)
Light aerobic workout courses (Harper, 2012)
Tai chi (same limitations as yoga poses)
Ballroom, Latin, and jazz dancing (avoid back bends, jumping, and spins)
Exercises to avoid: It is best to avoid exercises that involve extreme stretches or high-impact activities like aerobics and running that put a lot of stress on your joints and put you at risk for falls. Since the joints are loosened during pregnancy in preparation for a growing baby, labour, and delivery, you are at more risk for strains and sprains. Leg lifts, back bends, lying on the belly, and poses that stress the abdomen or pelvic floor should also be avoided
Stop exercises if you experience dizziness or light-headedness, headache, nausea or vomiting, overheating or dehydration,unusual vaginal discharge or bleeding, belly pain, lower back pain and fatigue. Call your doctor if these symptoms do not settle within 15 minutes of stopping exercise.(12)
To prevent mild dizziness, avoid prolonged standing. Also rise slowly after lying or sitting down.
If you feel dizzy while driving, then pull over to one side.
You may feel overheated easily. So wear clothes made of natural fibres and avoid synthetic ones.
Stay active and continue your normal activities during pregnancy
Use sunscreens when you go outdoors as skin pigmentation increases on sun exposure.
Use moisturizers over the stretch marks to relieve itching.
If you're having trouble with dizziness, drink plenty of fluids and rise slowly after lying or sitting down. When you feel dizzy, lie on your left side to restore your blood pressure.
As long as your pregnancy is proceeding normally and you are comfortable, you can have sex as often as you like unless your doctor has advised strict abstinence.
Ideal Weight Gain
If your pre-pregnancy weight was in the healthy range for your height (a BMI of 18.5 to 24.9), you should gain between 25 and 35 pounds, gaining 1 to 5 pounds in the first trimester and about 1 pound per week for the rest of your pregnancy for the optimal growth of your baby.
If you were underweight for your height at conception (a BMI below 18.5), you should gain 28 to 40 pounds.
If you were overweight for your height (a BMI of 25 to 29.9), you should gain 15 to 25 pounds.
If you were obese (a BMI of 30 or higher), you should gain between 11 and 20 pounds.
If you're having twins, you should gain 37 to 54 pounds if you started at a healthy weight, 31 to 50 pounds if you were overweight, and 25 to 42 pounds if you were obese.
Weight Management and Exercise
Gaining weight is important but gaining excess or less weight is not healthy. So never go on a diet or try to lose weight during pregnancy. Moderate exercise can help burn extra calories.
The more active and fit you are during pregnancy, the easier it will be for you to adapt to your changing shape and weight gain.
Smoking and Tobacco
Smoking and second hand smoking are significant factors in miscarriages during the first trimester and also contribute to a number of other threats to the health and development of the foetus. Hence it is advised to quit smoking.
Drinking alcohol during pregnancy, can permanently damage your developing baby's cells. Heavy drinking can also damage your baby's nervous system developing foetal alcohol spectrum disorders (FASD), with problems that can range from mild learning difficulties or social problems, through to birth defects.
Foetal alcohol syndrome (FAS) is at the extreme end of the spectrum of disorders. Babies with FAS tend to have facial defects, be born small, and carry on being small for their age. They also have learning difficulties, poor muscle tone and coordination, and behavioural problems, for the rest of their lives.
Hence avoid alcohol during pregnancy
Relaxation techniques like yoga, meditation and breathing exercises help reduce the stress during pregnancy.
Reduce the intake of tea, coffee, colas and chocolate especially later in the day. Lowered caffeine intake is known to induce a better sleep during the night.
Never take over the counter, herbal or any other medications without consulting your doctor.
Avoid fried foods, carbonated drinks, citrus fruits or juices, and spicy foods.
Include plenty of fiber in your diet
Drink lots of fluids.
Gaining adequate weight is very important during pregnancy for your health as well as the development of your baby. So below are some of the tips for a healthy diet.
Fresh fruits and vegetables make good snacks. They are full of vitamins and low in calories and fat.
Eat breads, crackers, and cereals made with whole grains.
Choose reduced-fat dairy products. You need at least four servings of milk products every day. However, using skim, 1%, or 2% milk will greatly reduce the amount of calories and fat you eat. Also choose low-fat or fat-free cheese or yogurt.
Naturally sweetened is better than foods and drinks with added sugar or artificial sweeteners.
Food and drinks that list sugar or corn syrup as one of the first ingredients are not good choices.
Many sweetened drinks are high in calories. Read the label and watch out for drinks that are high in sugar. Substitute water for sodas and fruit drinks.
Avoid junk-food snacks, such as chips, candy, cake, cookies, and ice cream. The best way to keep from eating junk food or other unhealthy snacks is to not have these foods in your house.
Do not add salt to foods when cooking. Salt causes your body to retain water.
Go light on fats. Fats include cooking oils, margarine, butter, gravy, sauces, mayonnaise, regular salad dressings, sauces, lard, sour cream, and cream cheese. Try the lower fat versions of these foods.
Most restaurants have menus and nutrition facts on their websites. Use these to plan ahead.
In general, eat at places that offer salads, soups, and vegetables.
Avoid fast food.
Cooking at home:
Prepare meals using low-fat cooking methods.
Frying foods in oil or butter will increase the calories and fat of that meal.
Baking, broiling, grilling, or boiling is healthier, lower-fat methods of cooking.(16)
Stages of Pregnancy and Signs: The second trimester often marks the ability to kick, make facial expressions and hear. Here is an overview of week wise development of your baby and possible associated signs with it.
Check out this link to know how your baby is growing inside you:
By now you will be feeling the baby movements regularly. Keep a count of the movements and monitor it.(5)