Just as you’ve had regular visits to your healthcare provider in your first trimester, you’ll continue to do so in your second trimester. These checkups help monitor the development and health of your baby — and your health as well.
Most pregnant people see their doctors every month for a prenatal checkup. You may see your doctor more often if you have a preexisting health condition or high-risk pregnancy.
During the second trimester, you’ll likely have an exciting 20-week ultrasound (actually, it’s often anywhere between 18 and 22 weeks). With this scan, you’ll get a good look at your developing baby — even their cute little fingers and toes!
You’ll likely have blood work, urine tests, and a glucose tolerance test, too (maybe not the most fun test, but certainly important to screen you for gestational diabetes).
You may also choose to get testing for complications in the development of the baby. Other tests may be recommended depending on individual health and medical history.
Be sure to tell your healthcare provider if there have been any changes in your diet, lifestyle, or health since your last visit. Don’t hesitate to call your OB-GYN or midwife with questions or concerns in between visits.
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 may recommend additional tests after getting your health history and performing a physical exam.
They 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 include 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
It can help to come prepared with a list of questions to ask your doctor during the 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
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’s usually 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 people with larger bodies, those who 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 recommend an ultrasound to check the baby and amniotic fluid.
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’s 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.
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. Though, more than likely, it’s just one of those fun side effects of pregnancy that will go away after giving birth.
Your doctor will note how much weight you’ve gained compared with your weight before pregnancy. They’ll also note how much weight you’ve gained since your last visit.
The amount of weight gain recommended during the second trimester will depend on your pre-pregnancy weight, number of babies you are carrying, and how much weight you have already gained.
If you’re gaining more weight than expected, you may consider making some changes to your diet. A nutritionist or dietitian can help you come up with an eating plan that includes the nutrients you need.
Some people who gain more weight than expected may not be overeating but gaining water weight, which is lost after delivery.
If you aren’t gaining enough weight, you’ll 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 and how much you eat 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 typically decreases during pregnancy due to new hormones in pregnancy and changes in your blood volume. It will usually reach its lowest at 24 to 26 weeks of pregnancy.
Some people 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, but is generally okay when it’s well managed.
If blood pressure is high or increasing, your doctor may check you for other symptoms of gestational hypertension or preeclampsia.
Many people have healthy babies despite high blood pressure during pregnancy. It’s important to get monitored regularly, so you can manage high blood pressure if you have it.
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, which is high blood pressure with swelling and possibly 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, a condition that causes you to develop high blood sugar levels.
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.
In addition to your regular checkups, you might have additional tests during your second trimester, depending on any health risks or complications that develop. Some tests include:
Ultrasound has become an essential tool for the evaluation of your baby during pregnancy. They’re completely safe for you and your baby, and they’re typically a much-anticipated opportunity to get a sneak peek of your sweet babe.
Many 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. A second trimester ultrasound will also be able to check fetal anatomy, the placenta, and the amniotic fluid.
While an ultrasound in the second trimester can provide lots of information, it does have limitations. 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.
Triple screen test
In the second trimester, most people under the age of 35 are offered a triple screen test. This is also sometimes called “multiple marker screening” or “AFP plus.” During the test, the mother’s blood is tested for three substances.
- AFP, which is a protein produced by your baby
- hCG, which is a hormone that’s produced in the placenta
- estriol, which is a type of estrogen produced by both placenta and baby
Screening tests look for abnormal levels of these substances. The test is typically given 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 test results don’t always mean there is something wrong. 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 tests 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 your baby’s risk of having a chromosomal disorder. This is a newer test, typically offered to people with pregnancies at increased risk for trisomy 13, 18, or 21.
The American College of Gynecologists (ACOG) notes that this test, like the triple screen test, is used as a screening and not as a diagnostic tool. In other words, if you have a positive cffDNA test, you’ll need a follow-up diagnostic test to confirm a chromosomal abnormality in your baby.
Cell-free fetal DNA is a genetic material released by the placenta. It can be detected in your blood. It shows the genetic makeup of your baby and can detect chromosomal disorders.
While the cffDNA test is more precise in testing for chromosomal abnormalities, it’s still recommended that pregnant people get the triple screen test. The triple screen test checks the blood for both chromosomal abnormalities and neural tube defects.
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 needle through your skin and into your amniotic sac. They’ll check your amniotic fluid for any chromosomal and genetic abnormalities in your baby.
Amniocentesis is considered an invasive procedure. It 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.
Amniocentesis 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 baby 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. However, ultrasound results will not always be accurate because they don’t analyze the fetal chromosome. Amniocentesis provides a more definite diagnosis.
One-hour glucose tolerance test
ACOG recommends that all pregnant people be screened for gestational diabetes using a 1-hour oral glucose tolerance test.
For this test, you’ll 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 3-hour glucose tolerance test. This is similar to the 1-hour test. Your blood will be drawn after waiting 3 hours.
Gestational diabetes causes your body to have 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.
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 issues for you and your baby. If they’re detected early you can treat them before your baby is born.
If your healthcare provider detects an abnormality in your baby, you’ll have plenty of opportunity to learn more about the condition from either your doctor or specialists. 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 and your healthcare provider can work closely together 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 recommend bed rest or emergency medication.
Remember that your doctor is an important ally. Use your checkups as opportunities to gather information. No question is off the table! Your healthcare providers have heard it all, and they are on hand to help address your concerns and make you feel comfortable throughout your pregnancy.
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.