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What To Expect, Development & Tests

What is the second trimester of pregnancy?

The typical pregnancy lasts about 40 weeks. It’s divided into three periods of time — the first, second and third trimester. Each trimester is roughly 14 weeks long. When you enter your second trimester, you are around 14 weeks pregnant. This middle trimester will last from week 14 to the end of week 27.

During your second trimester of pregnancy, you’ll start looking and feeling more pregnant. For many people, this is the best part of pregnancy because the morning sickness and fatigue of their first trimester fade into the past. Often, any anxiety that went with your first trimester also starts to diminish at this point. You’ll start to feel your fetus move by the end of this trimester, and you might begin to settle into your pregnancy and enjoy it more. Of course, it’s important to remember that pregnancy is different for everyone. Some people never experience negative symptoms like morning sickness in their first trimester. Others might continue to feel sick well into their second trimester of pregnancy.

How does my baby develop during the second trimester of pregnancy?

Your fetus will go through many changes during your second trimester of pregnancy. During this trimester, the fetus starts to look more like a child — with its facial features aligning, and its fingers and toes becoming well-defined. By month four, the fetus will actually have eyelids, eyebrows, eyelashes, nails and hair. The fetus will also be able to stretch, make faces and even suck on its thumb. You’ll soon be able to determine the sex of the fetus on an ultrasound — often around 20 weeks.

At this point, you might also start feeling the fetus move. The movement is often described as a flutter or similar to the feeling of having butterflies in your stomach. The fetus will be doing flips and movements throughout your second trimester. This first movement is called the quickening. If this isn’t your first pregnancy, you might feel the fetus move sooner.

In the last few weeks of the second trimester, the fetus can also hear you. If you talk to your growing belly, you might notice movement in response.

If your baby was born at the end of your second trimester (premature birth), they would be likely to survive with intensive care.

What happens to my body during the second trimester of pregnancy?

The fetus isn’t the only one growing and changing during your second trimester. You'll notice several changes in your own body during this time. Your uterus — the place where the fetus grows during pregnancy — continues to stretch. This organ will expand throughout your pregnancy as the fetus gets larger. After pregnancy, your uterus will return to its pre-pregnancy size (picture an upside-down pear).

However, your uterus isn’t the only thing growing during the second trimester either. You’ll start gaining weight and might start developing the tell-tale enlarged belly of a pregnant person. Don’t worry if this takes time to develop. Everyone is different, and no two bodies will look exactly the same during pregnancy.

You might also feel or develop a few new symptoms of pregnancy during your second trimester, including:

• An increased appetite.
• An achy body.
• Some swelling in your hands, feet and ankles.
• Some stretch marks.

If you experienced morning sickness during your first trimester, it’s likely fading away now. The uncomfortable symptoms of early pregnancy (nausea and extreme fatigue, for example) don’t typically continue into your second trimester. This is one reason why many people consider their second trimester of pregnancy to be the best part of pregnancy.

What tests will I have during the second trimester of pregnancy?

Throughout your pregnancy, your healthcare provider will order various tests to check on your health and the health of your developing fetus. During your second trimester, you’ll typically be screened for a few different things, including the Rh factor of your blood and the condition gestational diabetes. You'll also have an ultrasound during your second trimester. This ultrasound is probably best known for telling new parents the sex of the fetus, but it’s mainly used to look at their anatomy.

One thing your provider will test for during your second trimester is your Rh factor. Rh factor is an antigen protein found on most people’s red blood cells. If you don’t have the protein, then you are Rh- (negative). You’ll be given an injection of Rh immune globulin (called Rhogam®) during the 28th week of your pregnancy to prevent the development of antibodies that could be harmful to the fetus. You’ll also be given an injection of Rhogam® after delivery if your fetus has Rh+ (positive) blood.

If you are Rh-, you may also receive this injection if you:

• Are having an invasive procedure (such as amniocentesis).
• Had an abdominal trauma.
• Had any significant bleeding during pregnancy.
• Need to have the fetus turned in your uterus (due to breech presentation).

Your provider will also order a test called the oral glucose screening test. This is usually done at the end of your second trimester — often between weeks 24 and 28. The purpose of the glucose screening test is to see if you are developing gestational diabetes. During the test, you’ll be given a syrup-like drink. The healthcare provider administering this test will give you a set amount of time to drink the entire bottle, then you'll be asked to wait nearby for one hour. After the hour is over, you’ll have your blood drawn. Your healthcare provider will then go over your test results with you.

What do I need to prepare or plan for during the second trimester of pregnancy?

There are many things you can start thinking about during your second trimester of pregnancy to prepare for your new family member. Many of these things will center around conversations that you should start having at this point in your pregnancy. It’s good to discuss the type of birth you hope to have and learn about the different ways your child might be born.

A few ways your baby could be born can include:

• Vaginal birth (this could be medicated so that your pain is decreased, or unmedicated).
• Assisted birth (you might need tools like forceps or a vacuum to help with your delivery).
• Cesarean section (C-section).

You can learn more about these types of birth through your own research or in a birth class. This is the time for you to look into educational classes about birth, breastfeeding and parenting of your newborn. These classes can help prepare you for your new role as a parent. Ask your healthcare provider for more information on classes and groups you can join at this point in your pregnancy.

This might also be a good time to take a tour of the hospital where you’ll give birth. A hospital tour is a great way to get familiar with the place where your baby will be born. During the tour, you’ll learn where you should go when you first get to the hospital during labor and what will happen afterward. You’ll typically get to see hospital rooms and learn more about the hospital staff, as well.

What should I be doing during the second trimester of pregnancy to stay healthy?

Throughout your second trimester, you should continue maintaining a healthy lifestyle. Try to exercise for about 20 minutes a day. Regular exercise is good for you and your developing fetus. Some of the safest types of exercise include walking and swimming; though, there are many other options you can try. Talk to your healthcare provider about the type of exercise you'd like to do beforehand just to be safe. You’ll want to avoid contact sports and activities where you could fall, as these could endanger your pregnancy.

It’s also a good idea to do kegel exercises throughout your entire pregnancy. These exercises will help strengthen your pelvic floor muscles.

Apart from exercise, you should continue eating a healthy diet, taking your prenatal vitamins and attending each of your appointments.

When should I call my doctor during the second trimester of pregnancy?

You’re the person who knows your body the best. If you ever feel like something is wrong, it’s completely OK to reach out to your healthcare provider. It’s also a good idea to call your healthcare provider right away if you have:

• Unusual or severe cramping or abdominal pain.
• Noticeable changes in how much the fetus moves (after 28 weeks of gestation). If you don’t count six to 10 movements in one hour or less, call your provider.
• Difficulty breathing or shortness of breath that seems to be getting worse over time.

You should also reach out to your provider right away if you start having any signs of premature labor. Talk with your provider if you have any of the following signs of premature labor:

• Regular tightening or pain in your lower abdomen or back that occurs more than four times in an hour.
• Any bleeding in your second or third trimester of pregnancy.
• Any fluid leakage. Vaginal discharge often increases as part of the hormonal changes in pregnancy.
• Pressure in your pelvis or vagina.

Second trimester of pregnancy (from 13 to 28 weeks)

The beginning of the second trimester is traditionally considered one of the calmest. Walk more. Walking is very helpful. Sit down to rest only when you are tired. Movement in the fresh air improves the supply of oxygen to the fetus, which is very necessary for its normal development.

Nausea disappears, appetite improves. Do not eat a lot of salty, refuse marinades, smoked meats, if you have not done this before. The increased need of the child's body for proteins and vitamins begins. The daily diet should include meat or fish (boiled or stewed), dairy products, especially cottage cheese, eggs. Do not forget about vegetables, fruits, greens. An excellent source of vitamin C is sauerkraut (rather than salted) cabbage. Salads from carrots, cabbage, beets, apples, green radish should be on your table every day.

At 17-20 weeks you will feel your baby's first kicks. From them you can determine how comfortable the baby feels. Intense tremors are a signal of lack of oxygen. Maybe you haven’t walked for a long time or, on the contrary, you are engaged in hard physical labor. Get out into the fresh air or lie down to rest and you will immediately feel how the child has calmed down.

But the lack of movement is an alarm. See a doctor immediately!

The fetal need for calcium sharply increases - intensive growth of the skeleton has begun. If you don't have enough free calcium in your body right now, you could lose your teeth. To prevent this from happening, start taking calcium supplements in consultation with your doctor.

At this time, toxicosis of the second half of pregnancy may occur, the child suffers greatly from it. Therefore, if the doctor suggests hospitalization, do not refuse. Toxicosis can, if not be avoided, then at least reduce its manifestations. Be sure to follow your diet. Completely exclude salty, smoked, fried, spicy, canned food, chocolate. Do not eat a lot of grapes and drink fresh milk. Limit flour and rich products. As before, your diet should include boiled meat and fish, oatmeal and buckwheat porridge, vegetables and fruits

Periodically, once a week, check for fluid retention in the body. It is allowed to release liquid 200-300 ml less than what was drunk. If little urine is released, this is a signal of latent edema and the onset of toxicosis.

It is very good if you can measure your blood pressure at home. Show the results of measurements at the next visit to the doctor. Both high and too low pressure should alert. With low pressure, blood sluggishly crosses the placenta, and the baby does not receive enough nutrients.

Do not neglect blood tests - it is important not to miss the development of anemia. In this case, you will be prescribed iron supplements and multivitamins. The diet should include beef liver, tomato juice, buckwheat porridge, apples, preferably Antonovskie (they contain more iron than other varieties).

Women who are at risk of giving birth to a child with a genetic pathology (those who have severe hereditary ailments in their families), as well as women over 35 years old (they have an increased likelihood of having a child with Down syndrome) are referred for a consultation by a geneticist.

In case of a normal pregnancy at 20-22 weeks of pregnancy, a second scheduled ultrasound examination is prescribed.

Second trimester of pregnancy: 4, 5, 6 months

Second trimester of pregnancy

The second trimester of pregnancy lasts from 12 to 27 weeks. During this period, you will continue to be monitored by a specialist doctor with visits once every 3 weeks, pass a number of necessary tests, in particular, a complete blood count, a biochemical blood test, blood for a coagulogram, a glucose tolerance test, a general urinalysis and bacteriological culture of urine for sterility ^1-3 . At a period of 18-21 weeks, an ultrasound of the fetus will be performed with an assessment of its condition.

Second trimester abdomen

The circumference of your abdomen noticeably increases, by the end of the second trimester of pregnancy, the increase in the abdomen is more noticeable, and the bottom of the uterus is located at the level of the navel. Wear comfortable clothes, avoid tight belts, elastic bands in the abdomen ^1-3 .

Second trimester of pregnancy and pain

In case of sudden pains of a different nature (cramping sharp or monotonous pulling pains) of the abdomen, you should immediately consult a doctor. Pain in the abdomen may be associated with the threat of abortion and other complications. If the 2nd trimester is coming to an end and you have pain in the lumbar region, this may be due to compression of the ureters by the enlarged uterus. It is necessary to pass a urine test and do an ultrasound of the kidneys ^1-3 .

Constipation can also cause pain in the abdomen, along the final section of the large intestine (sigmoid colon). Pain during bowel movements, that is, during bowel movements, may be associated with an increase in hemorrhoids, the appearance of anal fissures. To ensure regular bowel movements, follow the drinking regimen and diet ^1-3 .

The 2nd trimester of pregnancy may be accompanied by headaches (cephalgia). One of the causes of cephalalgia during pregnancy can be an increase in blood pressure. When a headache occurs, control the level of blood pressure (you need to measure at rest, on both hands at least one measurement on each). Remember that headaches and high blood pressure require urgent medical attention ^1-3 .

Fourth month of pregnancy and fetal development

• All your baby's organs are already formed, his height is about 10 cm, and his weight is about 70 grams, he makes active movements in the joints.
• By the end of 4 months, the fetus actively increases in size, its height is about 13 cm, weight is about 140 grams.
• Teeth, sweat, salivary glands develop, the liver begins to produce bile, and the pancreas begins to produce insulin.

• The baby begins to move his eyes, blink, and hear sounds well, because the bones of the inner ear are already formed.
• By the end of the fourth month, a woman begins to feel the movements of her baby.
• The liver and spleen form blood cells.

Fifth month of pregnancy and fetal development

• The fetus is actively moving, on ultrasound you can see how the baby sucks his fingers. Weight about 240 grams, height about 15 cm.
• At 5 months, the intestines of the fetus are formed and individual nutrients can be absorbed, meconium accumulates.
• The immune system is fully formed and blood cells begin to produce bone marrow. The 5th month is coming to an end, and the baby's weight is about 400 grams.

• Your belly at 5 months of pregnancy no longer allows you to wear ordinary trousers and jeans, but dresses from an ordinary wardrobe may still fit, the uterus is just below the level of the navel.
• The breast at the 5th month of pregnancy also increases, usually by 1 size, the areolas of the nipples become more pigmented.

Sixth month of pregnancy and fetal development

• The most intensive growth of the fetus begins, which will continue for only 3 trimesters.
• At the beginning of this period, the weight of the fetus is about 500-600 grams, and by the end of 6 months, the weight of the baby already reaches 900 grams.

• The 6th month of pregnancy is characterized by the formation of the surfactant system and the maturation of your baby's lungs.
• The breast at 6 months of pregnancy continues to increase due to the growth of glandular tissue, the size and pigmentation of the areola increases, the mammary glands prepare for lactation under the influence of estrogens.

2nd trimester of pregnancy:

Pregnancy and iodine:

• To prevent iodine deficiency, all pregnant and lactating women are advised to take 200 micrograms of potassium iodide daily.
• Optimal absorption of iodides is observed in the morning hours. ^4-8

Talk to your doctor about taking potassium iodide.

Pregnancy and calcium:

• The need for calcium increases to 1200-1500 mg per day, calcium salts are most often found in the form of carbonate and citrate, they have good bioavailability.
• Calcium is well absorbed in the evening hours. ^9-11

Discuss the need to take calcium salts with your doctor.

Pregnancy and iron:

• Iron preparations are not recommended for all women, but iron deficiency anemia often accompanies the 2nd trimester of pregnancy ⁴ .
• If the level of ferritin (an accessible and reliable indicator of iron sufficiency) decreases, iron supplements should be taken at an average dose of 30-60 mg per day ⁴ .

The decision to prescribe iron supplements is made by your doctor or hematologist.

Pregnancy and vitamin D:

• The requirement for vitamin D throughout pregnancy and lactation is 2000 IU per day ^9-11 .

Ask your doctor if you need to take vitamin D.

Second trimester pregnancy and complications

When the above symptoms appear, either alone or in combination, i.e. several symptoms at once, you need to urgently consult a doctor, since the lack of specialized medical care may be associated with a risk to your life and the life of the child.

2nd trimester and gestational diabetes mellitus

• The list of mandatory examinations now includes a standard glucose tolerance test. Based on the results of this test, the state of carbohydrate metabolism is judged.
• In the presence of deviations from the norm, you will first of all be advised to follow a diet with a sharp restriction of fast carbohydrates and physical activity in accordance with the general state of health and the characteristics of the course of pregnancy.
• It will be necessary to consult an endocrinologist, nutritionist, physiotherapist.

2nd trimester and preeclampsia

• An increase in blood pressure (may be asymptomatic!), the appearance of protein in the urine and edema are manifestations of preeclampsia.

• It is important to have regular blood pressure measurements, urinalysis, and weight gain.

2nd trimester and pyelonephritis

• With an increase in the duration of pregnancy, the risk of developing pyelonephritis increases, this is due to a violation of the outflow of urine due to compression of the ureters by the growing uterus.

• Sitting and supine position contribute to urinary obstruction.
• Motor activity, knee-elbow position make urine outflow optimal.

• 1. National guidance. Gynecology. 2nd edition, revised and enlarged. M., 2017. 446 p.
• 2. Guidelines for outpatient care in obstetrics and gynecology. Edited by V.N. Serov, G.T. Sukhikh, V.N. Prilepskaya, V.E. Radzinsky. 3rd edition, revised and expanded. M., 2017. S. 545-550.
• 3. Obstetrics and gynecology. Clinical guidelines. — 3rd ed., rev. and additional / G.M. Savelyeva, V.N. Serov, G.T. Dry. — M.: GEOTARMEDIA. 2013. - 880 p.
• 4. WHO recommendations for antenatal care for a positive pregnancy experience. 2017.196 s. ISBN 978-92-4-454991-9
• 5. Dedov I.I., Gerasimov G.A., Sviridenko N.Yu. Iodine deficiency diseases in the Russian Federation (epidemiology, diagnosis, prevention). Toolkit. — M.; 1999.
• 6. Iodine deficiency: current state of the problem. N.M. Platonov. Clinical and experimental thyroidology. 2015. Volume 11, No. 1. S. 12-21.
• 7. Melnichenko G.A., Troshina E.A., Platonova N.M. Iodine deficiency diseases of the thyroid gland in the Russian Federation: the current state of the problem. Analytical review of publications and official state statistics (Rosstat). Consilium Medicum. 2019; 21(4):14–20. DOI: 10.26442/20751753.2019.4.19033
• 8. Clinical guidelines: diagnosis and treatment of (multiple) nodular goiter in adults. 2016. 9 p.
• 9. National program for optimizing the feeding of children in the first year of life in the Russian Federation (4th edition, revised and supplemented) / Union of Pediatricians of Russia [et al.]. — M.: Pediatr, 2019. — 206 p.
• 10. National Program Vitamin D Deficiency in Children and Adolescents of the Russian Federation: Modern Approaches to Correction / Union of Pediatricians of Russia [and others]. — M.: Pediatr, 2018. — 96 s.
• 11. Pigarova E. A., Rozhinskaya L.Ya, Belaya Zh.E., et al. Clinical guidelines of the Russian Association of Endocrinologists for the diagnosis, treatment and prevention of vitamin D deficiency in adults // Problems of Endocrinology. - 2016. - T.62. — No. 4. — P. 60-84.
• 12. Russian national consensus "Gestational diabetes mellitus: diagnosis, treatment, postpartum care" / Dedov I.I., Krasnopolsky V.I., Sukhikh G.T. On behalf of the working group//Diabetes mellitus. —2012. -No4. —S.4-10.
• 13. Clinical guidelines. Algorithms of specialized medical care for patients with diabetes mellitus. 9th edition (updated). 2019. 216 p.
• 14. Adamyan L.V., Artymuk N.V., Bashmakova N.V., Belokrinitskaya T.E., Belomestnov S.R., Bratishchev I.V., Vuchenovich Yu.D., Krasnopolsky V.I. , Kulikov A.V., Levit A.L., Nikitina N.A., Petrukhin V.A., Pyregov A.V., Serov V.N., Sidorova I.S., Filippov O.S., Khodzhaeva Z.S., Kholin A.M., Sheshko E.L., Shifman E.M., Shmakov R.G. Hypertensive disorders during pregnancy, childbirth and the postpartum period.

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