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The Importance of Checkups in the Second Trimester

Overview

Most pregnant women see their doctors every month for a prenatal checkup. Women with health problems or high-risk pregnancies may see their doctors more often. Regular checkups are important during the first trimester of your pregnancy. They’re also important during your second trimester. You need to continue monitoring the development and health of your baby.

During the second trimester, many women will have a variety of tests done. Most women will have an ultrasound. They’ll also get blood work, urine tests, and a glucose tolerance test done.

Some women may choose to get testing for complications in the development of their babies. Other tests may be recommended depending on a woman’s health and medical history.

Be sure to tell your doctor if there have been any changes in your diet, lifestyle, or health since your last visit. Don’t hesitate to call your doctor with questions or concerns in between visits.

During a checkup

During your checkup your doctor will do a brief physical exam. A nurse or assistant will check your weight and take your blood pressure. Your doctor will decide whether any more tests are needed after getting your health history and performing the physical exam.

Your doctor may also want to know your family medical history and any medications or supplements you’re taking. Your doctor will also ask you about:

  • fetal movement
  • sleep patterns
  • diet and prenatal vitamin use
  • symptoms of preterm labor
  • symptoms of preeclampsia, such as swelling

Physical assessments during the second trimester usually require the following checks:

  • fundal height, or belly size, and fetal growth
  • fetal heartbeat
  • edema, or swelling
  • weight gain
  • blood pressure
  • urine protein levels
  • urine glucose levels

You will want to compile a list of questions before your doctor visit. Also, be sure to see your doctor immediately if you experience symptoms that include:

  • vaginal bleeding
  • severe or continuous headache
  • dimness or blurring of vision
  • abdominal pain
  • persistent vomiting
  • chills or fever
  • pain or burning during urination
  • leaking of fluid from vagina
  • swelling or pain in one lower extremity

Fundal height

Your doctor will measure the height of your uterus, also called the fundal height, measuring from the top of your pelvic bone to the top of your uterus. There usually is a relationship between the fundal height and the length of your pregnancy. For example, at 20 weeks, your fundal height should be 20 centimeters (cm.), plus or minus 2 cm. At 30 weeks, 30 cm., plus or minus 2 cm., and so on.

This measurement isn’t always accurate as fundal height may be unreliable in women who are obese, have fibroids, are carrying twins or multiples, or who have excess amniotic fluid.

Your doctor will use the increase in your uterine size as a marker for fetal growth. Measurements can vary. A 2 or 3 cm. difference is generally not a cause for concern. If your fundal height doesn’t grow or is growing slower or faster than expected, your doctor may order an ultrasound to check the fetus and amniotic fluid.

Fetal heartbeat

Your doctor will check whether your baby’s heart rate is too fast or too slow using Doppler ultrasound. Doppler technology uses sound waves to measure the heartbeat. It is safe for you and your baby. Fetal heart rate is usually faster in early pregnancy. It can range from 120 to 160 beats per minute.

Edema

Your doctor will also check your legs, ankles, and feet for swelling, or edema. Swelling in your legs is common in pregnancy and generally increases in the third trimester. Abnormal swelling might indicate a problem like preeclampsia, gestational diabetes, or a blood clot.

Weight gain

Your doctor will note how much weight you’ve gained compared with your weight before pregnancy. Your doctor will also note how much weight you’ve gained since your last visit.

The amount of weight you need to gain during the second trimester will depend on your prepregnancy weight, number of fetuses you are carrying, and how much weight you have already gained.

If you are gaining more weight than expected, you may need to limit your intake of fruits and sweets. If this doesn’t curb weight gain, you may want to write down what you’re eating to help your doctor evaluate your diet. Some women who gain too much weight may not be overeating but gaining water weight, which is lost after delivery.

If you aren’t gaining enough weight, you will need to supplement your diet. Your doctor may recommend eating two or three healthy snacks each day in addition to what you've been eating. Writing down what you eat and how much, will help your doctor come up with a plan to keep you and your baby nourished. If you still aren’t gaining enough weight you may want to consult a dietitian.

Blood pressure

Blood pressure typically decreases during pregnancy due to new hormones in pregnancy and changes in your blood volume. Blood pressure will usually reach its lowest at 24 to 26 weeks of pregnancy. Some women will have low blood pressure in their second trimester, for example, 80/40. As long as you feel well, it’s not a cause for concern.

High blood pressure can be dangerous during pregnancy. If yours is high or increasing, your doctor may check you for other symptoms of gestational hypertension or preeclampsia. Many women have healthy babies despite high blood pressure during pregnancy, but others may become ill or give birth prematurely.

Urinalysis

Each time you go in for a checkup, your doctor will check your urine for the presence of protein and sugars. The greatest concern with protein in your urine is development of preeclampsia. This is high blood pressure with swelling and excessive protein in your urine.

If you have high glucose levels, your doctor may perform other tests. These may include a test for gestational diabetes. This condition can lead to problems with your and your baby’s health during pregnancy.

If you have symptoms like painful urination, your doctor may check your urine for bacteria. Urinary tract, bladder, and kidney infections can cause bacteria to appear in your urine. If this happens, you may be prescribed antibiotics that are safe to take during pregnancy.

Medications and supplements

Continue to take your multivitamins and iron pills. If you are having heartburn, you can take over-the-counter (OTC) antacids. If you have questions about new medications or OTC drugs like pain pills or cough medicine, discuss them and any new supplements or medication with your doctor.

Further testing during the second trimester

In addition to your regular checkups, you will have additional tests during your second trimester, depending on any health risks or complications that develop. Some tests include:

Ultrasound

Ultrasounds are safe for you and your baby. Ultrasound has become an essential tool for the evaluation of your baby during pregnancy. The need for one depends on how far into your pregnancy you are and if there are any complications.

Many women have an ultrasound in the first trimester to confirm pregnancy. Some will wait until the second trimester if they have a low risk for complications. Also, if the first trimester pelvic exam agreed with menstrual dating, the time of your last menstrual period, the ultrasound may wait until the second trimester.

A second trimester ultrasound can confirm or change the menstrual dating and the stage of your pregnancy to within 10 to 14 days. Between 13 and 27 weeks of pregnancy an ultrasound will also be able to check fetal anatomy, the placenta, and the amniotic fluid.

It’s important to understand that there are limitations to diagnosis by fetal ultrasound. Some anatomical problems are easier to see than others, and some can’t be diagnosed before birth. For example, excessive fluid buildup in the brain (hydrocephalus), can usually be diagnosed with ultrasound, but small defects in the heart often go undetected before birth. Your doctor will let you know of any detectable abnormalities.

Triple screen test

In the second trimester, all women under the age of 35 should be offered a triple screen test. This is also sometimes called “multiple marker screening” and “AFP plus.” During the test, the mother’s blood is tested for three substances. These are:

  • AFP, which is a protein produced by the fetus
  • hCG, which is a hormone that’s produced in the placenta
  • estriol, which is a type of estrogen produced by both placenta and fetus

Screening tests look for abnormal levels of these substances They are considered along with factors like the mother’s age, health history, and ethnicity. The test is typically administered between 15 and 22 weeks of pregnancy. The best time for the test is between 16 and 18 weeks.

The triple screen tests can detect fetal abnormalities like Down syndrome, trisomy 18 syndrome, and spina bifida.

Abnormal triple screen tests don’t mean there is an abnormality in the fetus. Instead, it could indicate risk of a complication, and further testing should be done.

For high risk pregnancies, if a triple screen test comes back with abnormal results, your doctor may recommend further testing. In some cases, amniocentesis or chorionic villus sampling might be done. These test are more precise than the triple screen test, but have an increased risk of complications. Ultrasounds are also sometimes used to look for conditions that could cause abnormal results.

Cell-free fetal DNA test

A cell-free fetal DNA (cffDNA) test may be used to assess the fetus’s risk of having a chromosomal disorder. This is a newer test, but the American College of Obstetrics and Gynecologists recommends that the test is offered to women with pregnancies at increased risk for trisomy 13, 18, or 21. This test, like the triple screen test, is used as a screening and not as a diagnostic tool.

Cell-free fetal DNA is a genetic material released by the placenta. It can be detected in the mother’s blood. It shows the genetic makeup of the fetus, and can detect chromosomal disorders.

While the cffDNA test is more precise in testing for chromosomal abnormalities, it is still recommended that pregnant women get the triple screen test. The triple screen test checks the mother’s blood for both chromosomal abnormalities and neural tube defects.

Amniocentesis

Unlike the triple screen tests, amniocentesis can provide a definite diagnosis. During this procedure, your doctor will take a sample of your amniotic fluid by inserting a small needle through your skin and into your amniotic sac. Your doctor will check your amniotic fluid for chromosomal and genetic abnormalities in the fetus.

Amniocentesis is an invasive procedure that carries a small risk of losing the pregnancy. The decision to get one is a personal choice. It’s only used when the benefits of the test results outweigh the risks of performing the test.

The test can provide you with information that only you may use to make decisions, or to alter the course of your pregnancy. For example, if knowing that your fetus has Down syndrome would not alter the course of the pregnancy, amniocentesis may not benefit you.

Also, if your doctor finds that an ultrasound already indicates a disorder, you may decide against amniocentesis. It’s important to realize that ultrasound results will not always be accurate because they don’t analyze the fetal chromosome. Amniocentesis is for people who want a definite diagnosis.

One-hour glucose tolerance test (Glucola)

The American Congress of Obstetrics and Gynecologists (ACOG) recommends that all pregnant women be screened for gestational diabetes using a one-hour oral glucose tolerance test. For this test, you will have to drink a sugar solution, generally containing 50 grams of sugar. After one hour, you’ll have your blood drawn to check your sugar level.

If your glucose test is abnormal, your doctor will recommend a three-hour glucose tolerance test. This is similar to the one-hour test. Your blood will be drawn after waiting three hours.

If you have gestational diabetes, your body has trouble controlling the amount of sugar in your blood. Controlling your blood sugar level is important for a healthy delivery.

If you have gestational diabetes, you may need to make changes in your diet and exercise habits, or take medication. Gestational diabetes normally goes away after you have your baby.

Other tests

Depending on your obstetrical history and your current health, your doctor may perform additional tests for:

  • blood count
  • platelet count
  • RPR, a rapid plasma reagin test for syphilis
  • sexually transmitted infections (STIs)
  • bacterial vaginosis

Some of these tests require a blood draw, and others require a urine sample. Your doctor may also need to swab your cheek, vagina, or cervix to test for infections.

Blood and platelet tests can identify a weak immune system or problems with blood clotting, which can complicate pregnancy and childbirth. STIs and other bacterial infections can also cause problems for you and your baby. If they’re detected early you can treat them before your baby is born.

Talking to your doctor

If an abnormality in your fetus is diagnosed, you and your doctor should discuss it. Your doctor may suggest you speak with a genetic counselor to learn about the problem’s cause, treatment, risk of recurrence, outlook, and prevention.

Your doctor will discuss options for managing your pregnancy. If pregnancy termination is an option, your doctor won’t tell you what decision to make. If termination is not an option due to your personal beliefs, the information your doctor shares with you may help you manage your pregnancy. In some cases, such as with neural tube defects, the outcome may improve with a cesarean delivery. Your doctor can also connect you with community resources to help you prepare for a baby with special needs.

If a maternal health problem is diagnosed, you will need to work with your doctor to treat or monitor the problem. Infections can usually be treated with antibiotics or proper rest and diet. More serious complications like hypertension or gestational diabetes, require frequent visits to the doctor. You may need to make changes to your diet or lifestyle. In some cases, your doctor may order bed rest or emergency medication.

Regardless of your diagnosis, you should feel comfortable talking to your doctor about any concerns. Use your checkups as opportunities to ask questions and learn about any problems in your pregnancy. If you don’t feel comfortable talking to your doctor, consider finding a new provider.

Outlook

It’s important to get routine checkups during pregnancy, especially during your second trimester. Many tests can help you identify and diagnose potential health problems for you and your developing baby.

Diagnosis of certain conditions can help you manage complications and health issues during your pregnancy. Be sure to bring up any questions or concerns with your doctor, and don’t hesitate to contact them outside of an office visit.

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