The Second Trimester (13-28 Weeks)

Prenatal visits during the second trimester:
During the second and third trimester prenatal visits, your physician or certified nurse midwife may check the following, depending on your current medical condition and the health of the fetus:

• any current symptoms or discomforts

• mother’s weight

• mother’s blood pressure

• urine test - to detect albumin (a protein) which may indicate preeclampsia or toxemia, and sugar (which may indicate hyperglycemia)

• growth, size, and development of the fetus

• size of the uterus -- after approximately 12 weeks of gestation, the uterus can be felt through the abdominal wall

• height of the fundus (top of the uterus)

• fetal heartbeat

What to expect during the second trimester:
The second trimester marks a turning point for mother and fetus. The mother usually begins to feel better and will start showing the pregnancy more. The fetus has now developed all its organs and systems and will now focus on growing in size and weight.

During the second trimester, the umbilical cord continues to thicken as it carries nourishment to the fetus. However, harmful substances also pass through the umbilical cord to the fetus, so care should be taken to avoid alcohol, tobacco, and other known hazards.

During the second trimester, both the mother’s body and the fetus continue to grow.

Fetal development during the second trimester (13-28 weeks):
Now that all the major organs and systems have formed in the fetus, the following six months will be spent growing. The weight of the fetus will multiply more than seven times over the next few months, as the fetus becomes a baby that can survive outside of the uterus.

By the end of the second trimester, the fetus will be about 13 to 16 inches long and weighs about 2 to 3 pounds. Fetal development during the second trimester (13-28 weeks) includes:

• The fetus kicks, moves, and can turn from side to side.

• The eyes have been gradually moving to the front of the face and the ears have moved from the neck to the sides of the head. The fetus can hear the mother's voice.

• A creamy white substance (called vernix caseosa, or simply vernix) begins to appear on the fetus and helps to protect the thin fetal skin. Vernix is gradually absorbed by the skin, but some may be seen on babies even after birth.

• The fetus is developing reflexes such as swallowing and sucking.

• The fetus can respond to certain stimuli.

• The placenta is fully developed.

• The brain will undergo its most important period of growth from the 5^th month on.

• Fingernails have grown on the tips of the fingers and toes, and the fingers and toes are fully separated.

• The fetus goes through cycles of sleep and wakefulness.

• Skin is wrinkly and red, covered with soft, downy hair (called lanugo).

• Hair is growing on the head of the fetus.

• Fat begins to form on the fetus.

• Eyelids are beginning to open and the eyebrows and eyelashes are visible.

• Fingerprints and toeprints have formed.

• Rapid growth is continuing in fetal size and weight.

• The 20^th week marks the halfway point of the pregnancy.

A fetus born at the end of 28 weeks may survive in a neonatal intensive care unit.

Changes in the mother's body:
The second trimester is the most physically enjoyable for most women. Morning sickness usually ends by this time and the extreme fatigue and breast tenderness usually is reduced. These changes can be attributed to a decrease in levels of human chorionic gonadotropin (HCG) hormone and an adjustment to the levels of estrogen and progesterone hormones.

The following is a list of changes and symptoms that may occur during the second trimester and includes:

• Appetite may increase.

• The mother may be able to feel the movement of the fetus for the first time -- a phenomenon called quickening -- by the end of the 5^th month.

• The mother may be able to feel active movement and kicking of the fetus by the end of the 7^th month.

• The uterus has grown to the height of the belly button, making the pregnancy visible.

• The skin on the belly may itch as it grows and there may be pain down the sides of the body as the uterus stretches. The lower abdomen may ache as ligaments stretch to support the uterus.

• The need to frequently urinate may decrease as the uterus grows out of the pelvic cavity, relieving pressure on the bladder.

• A mother’s nose may become congested and she may experience nosebleeds. This is due to the increase in hormones (estrogen and progesterone) that affect the mucous membranes in the nose.

• A woman's gums become more spongy and may bleed easily. This is due to the increase in hormones (estrogen and progesterone) that affect the mucous membranes in the mouth.

• Varicose veins and hemorrhoids may appear.

• A woman may have a white-colored vaginal discharge called leukorrhea. (A colored or bloody discharge may signal possible complications and should be examined immediately.)

• The increasing weight gain may cause backaches.

• Skin pigmentation may change on the face or abdomen due to the pregnancy hormones.

• Heart burn, indigestion, and constipation may continue.

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