Second trimester warning signs

The Second Trimester of Pregnancy: Complications

Medically reviewed by Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT — By April Kahn on December 3, 2018

Overview

The second trimester is often when people feel their best during pregnancy. Nausea and vomiting usually resolve, the risk of miscarriage has dropped, and the aches and pains of the ninth month are far away.

Even so, there are a few complications that can occur. Read on to learn what to watch for and how to prevent complications from occurring in the first place.

Bleeding

Although a miscarriage is much less common in the second trimester, it can still occur. Vaginal bleeding is usually the first warning sign. Miscarriages in the second trimester (before 20 weeks) may be caused by several different factors, which can include:

Uterine septum. A wall, or septum, inside the uterus divides it into two separate parts.
Incompetent cervix. When the cervix opens too soon, causing early birth.
Autoimmune diseases. Examples include lupus or scleroderma. These diseases can occur when your immune system attacks healthy cells.
Chromosomal abnormalities of the fetus. This is when something is wrong with the baby’s chromosomes, which are cells that are made up of DNA.

Other causes of bleeding in the second trimester include:

early labor
problems with the placenta, such as placenta previa (placenta covering the cervix)
placental abruption (placenta separating from the uterus)

These problems are more common in the third trimester, but they can also occur late in the second trimester.

If you have have Rh-negative blood, get an injection of immunoglobulin (RhoGAM) if you experience bleeding during pregnancy.

Immunoglobulin is an antibody. An antibody is a protein your immune system produces that recognizes and fights harmful substances, such as bacteria and viruses.

Getting a shot of immunoglobulin will help prevent the development of Rh antibodies, which will attack the fetus if it has an Rh-positive blood type.

You may feel scared if you experience vaginal bleeding, but it’s important to remember that not all bleeding means pregnancy loss.

Seek immediate care if you’re bleeding in pregnancy, but try to stay calm while the doctor understands why you’re bleeding. You may be put on bed rest until the bleeding stops.

Preterm labor

When labor occurs before the 38th week of pregnancy, it’s considered preterm. Various conditions may cause preterm labor, such as:

bladder infection
smoking
chronic health condition, like diabetes or kidney disease

Risk factors for preterm labor include:

a previous preterm birth
twin pregnancies
multiple pregnancies
extra amniotic fluid (the fluid surrounding the fetus)
infection of the amniotic fluid or amniotic membranes

Symptoms

The signs and symptoms of preterm labor may be subtle. They can include:

vaginal pressure
low back pain
frequent urination
diarrhea
increased vaginal discharge
tightness in the lower abdomen

In other cases, the symptoms of preterm labor are more obvious, such as:

painful contractions
leakage of fluid from the vagina
vaginal bleeding

Call your doctor if you have these symptoms and are worried about being in labor. Depending on your symptoms, your doctor may tell you to go to the hospital right away.

Treatment

Each additional day you don’t go into preterm labor offers a chance for fewer complications when the baby is born. Several medications can be helpful in stopping preterm labor. These include:

magnesium sulfate
corticosteroids
tocolytics

If preterm labor can’t be stopped, your doctor will give you a steroid medication. Doing so helps develop the baby’s lungs and reduces the severity of lung disease. It’s most effective two days after the first dose, so your doctor will try to prevent delivery for at least two days.

Preterm premature rupture of membranes (PPROM)

It’s normal for your membranes to rupture (break) during labor. People often refer to it as “your water breaking.”

This occurs when the amniotic sac surrounding the baby breaks, allowing the amniotic fluid to flow out. That bag protects the baby from bacteria. Once it’s broken, there’s a concern of the baby getting an infection.

While your water is supposed to break when you go into labor, it can cause serious problems for your baby when it happens too early. This is called preterm premature rupture of membranes (PPROM).

The exact cause of PPROM isn’t always clear. In many cases, though, the source of the problem is an infection of the membranes.

PPROM in the second trimester is a big concern, as it can lead to a preterm delivery. Infants born between the 24th and 28th weeks of pregnancy are at the greatest risk for developing serious long-term medical problems, particularly lung disease.

The good news is that with the appropriate intensive care nursery services, most preterm infants tend to do very well.

Treatment

Treatment for PPROM varies. It can often include:

hospitalization
antibiotics
steroids, such as betamethasone
medications that can stop labor, such as terbutaline

If there are signs of an infection, labor may be induced to avoid serious complications. Antibiotics will be started to prevent infection.

Many babies are born within two days of rupture, and most will deliver within a week. In rare cases, especially with a slow leak, the amniotic sac can reseal itself. Preterm labor can be avoided, and the baby is born closer to their due date.

Cervical incompetence (cervical insufficiency)

The cervix is a tissue that connects the vagina and the uterus. Sometimes, the cervix is unable to withstand the pressure of the growing uterus during pregnancy. The increased pressure can weaken the cervix and cause it to open before the ninth month.

This condition is known as cervical incompetence, or cervical insufficiency. While it’s an uncommon condition, it can cause serious complications.

The opening and thinning of the cervix eventually leads to the rupture of membranes and delivery of a very premature fetus. This usually occurs around the 20th week of pregnancy. Since the fetus is too premature to survive outside the uterus at that point, the pregnancy often can’t be saved.

Women are at a higher risk for cervical incompetence if they’ve had:

a previous cervical trauma, such as a tear during delivery
a cervical cone biopsy
other operation on the cervix

Symptoms

Unlike preterm labor, cervical incompetence typically doesn’t cause pain or contractions. There may be vaginal bleeding or discharge.

Treatment

Treatment for cervical incompetence is limited. An emergency cerclage (stitch around the cervix) is a possibility if the membranes haven’t ruptured yet. The risk of rupturing the membranes is higher if the cervix is very dilated (wide). Extended bed rest is necessary after the placement of a cerclage.

In other cases, when the membranes have already ruptured and the fetus is old enough to survive, your doctor will likely induce labor.

Prevention

You can prevent cervical incompetence. If you have a history of it, you can receive a cerclage with future pregnancies at about 14 weeks. This will lower, but not eliminate, the risk of having a preterm delivery and losing the baby.

Preeclampsia

Preeclampsia occurs when you develop:

high blood pressure
proteinuria (a large amount of protein in the urine)
excessive edema (swelling)

Preeclampsia affects every system in the body, including the placenta.

The placenta is responsible for providing nutrients to the baby. Though preeclampsia typically occurs during the third trimester for first-time pregnancies, some people develop preeclampsia during the second trimester.

Before making a diagnosis, your doctor will evaluate you for other conditions that may be confused with preeclampsia, such as lupus (which causes inflammation throughout the body) and epilepsy (a seizure disorder).

Your doctor will also evaluate you for conditions that can increase the likelihood of developing early preeclampsia, such as blood clotting disorders and molar pregnancy. That’s a noncancerous tumor that forms in the uterus.

Symptoms

Symptoms of preeclampsia include rapid swelling of your legs, hands, or face. Call your doctor right away if you experience this type of swelling or any of the following symptoms:

headache that doesn’t go away after taking acetaminophen (Tylenol)
loss of vision
“floaters” in your eye (specks or spots in your vision)
severe pain on your right side or in your stomach area
easy bruising

Injury

You’re more prone to injury during pregnancy. Your center of gravity changes when you’re pregnant, which means it’s easier to lose your balance.

In the bathroom, be careful when stepping into the shower or tub. You may want to add nonskid surfaces to your shower so you don’t slip. Consider adding grab bars or rails in your shower, too. Also check your house for other hazards that could cause you to fall.

Outlook

If you’re experiencing any of the symptoms described in this article, contact your doctor. They’ll be able to determine the cause and get you started on the right treatment — which means a happy and healthy pregnancy for you!

Last medically reviewed on December 3, 2018

Parenthood
Pregnancy
2nd Trimester

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Get the full 40 weeks of pregnancy. (n.d.).
health5mom.org/wp-content/uploads/2015/03/Go-The-Full-40-Implementation-Toolkit_2015-1.pdf
March of Dimes. (2015). Cervical insufficiency and short cervix.
marchofdimes.org/complications/cervical-insufficiency-and-short-cervix.aspx
March of Dimes. (2017). Miscarriage.
marchofdimes.org/complications/miscarriage.aspx
Mayo Clinic Staff. (2018). Preeclampsia.
mayoclinic.org/diseases-conditions/preeclampsia/basics/definition/con-20031644
Moldenhauer J. S. (2018). Premature rupture of membranes (PROM).
merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-complications-of-labor-and-delivery/premature-rupture-of-membranes-prom
Rundell K, et al. (2017). Preterm labor: Prevention and management.
aafp.org/afp/2017/0315/p366.html
WomensHealth.gov. (2018). Pregnancy complications.
womenshealth.gov/pregnancy/youre-pregnant-now-what/pregnancy-complications

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

Current Version

Dec 3, 2018

Written By

April Kahn

Edited By

Nizam Khan (TechSpace)

Medically Reviewed By

Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT

Share this article

Medically reviewed by Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT — By April Kahn on December 3, 2018

The Second Trimester of Pregnancy: Complications

Medically reviewed by Debra Rose Wilson, Ph. D., MSN, R.N., IBCLC, AHN-BC, CHT — By April Kahn on December 3, 2018

Overview

Even so, there are a few complications that can occur. Read on to learn what to watch for and how to prevent complications from occurring in the first place.

Bleeding

Uterine septum. A wall, or septum, inside the uterus divides it into two separate parts.
Incompetent cervix. When the cervix opens too soon, causing early birth.
Autoimmune diseases. Examples include lupus or scleroderma. These diseases can occur when your immune system attacks healthy cells.
Chromosomal abnormalities of the fetus. This is when something is wrong with the baby’s chromosomes, which are cells that are made up of DNA.

Other causes of bleeding in the second trimester include:

early labor
problems with the placenta, such as placenta previa (placenta covering the cervix)
placental abruption (placenta separating from the uterus)

These problems are more common in the third trimester, but they can also occur late in the second trimester.

If you have have Rh-negative blood, get an injection of immunoglobulin (RhoGAM) if you experience bleeding during pregnancy.

Immunoglobulin is an antibody. An antibody is a protein your immune system produces that recognizes and fights harmful substances, such as bacteria and viruses.

Getting a shot of immunoglobulin will help prevent the development of Rh antibodies, which will attack the fetus if it has an Rh-positive blood type.

You may feel scared if you experience vaginal bleeding, but it’s important to remember that not all bleeding means pregnancy loss.

Seek immediate care if you’re bleeding in pregnancy, but try to stay calm while the doctor understands why you’re bleeding. You may be put on bed rest until the bleeding stops.

Preterm labor

When labor occurs before the 38th week of pregnancy, it’s considered preterm. Various conditions may cause preterm labor, such as:

bladder infection
smoking
chronic health condition, like diabetes or kidney disease

Risk factors for preterm labor include:

a previous preterm birth
twin pregnancies
multiple pregnancies
extra amniotic fluid (the fluid surrounding the fetus)
infection of the amniotic fluid or amniotic membranes

Symptoms

The signs and symptoms of preterm labor may be subtle. They can include:

vaginal pressure
low back pain
frequent urination
diarrhea
increased vaginal discharge
tightness in the lower abdomen

In other cases, the symptoms of preterm labor are more obvious, such as:

painful contractions
leakage of fluid from the vagina
vaginal bleeding

Call your doctor if you have these symptoms and are worried about being in labor. Depending on your symptoms, your doctor may tell you to go to the hospital right away.

Treatment

Each additional day you don’t go into preterm labor offers a chance for fewer complications when the baby is born. Several medications can be helpful in stopping preterm labor. These include:

magnesium sulfate
corticosteroids
tocolytics

Preterm premature rupture of membranes (PPROM)

It’s normal for your membranes to rupture (break) during labor. People often refer to it as “your water breaking.”

While your water is supposed to break when you go into labor, it can cause serious problems for your baby when it happens too early. This is called preterm premature rupture of membranes (PPROM).

The exact cause of PPROM isn’t always clear. In many cases, though, the source of the problem is an infection of the membranes.

The good news is that with the appropriate intensive care nursery services, most preterm infants tend to do very well.

Treatment

Treatment for PPROM varies. It can often include:

hospitalization
antibiotics
steroids, such as betamethasone
medications that can stop labor, such as terbutaline

If there are signs of an infection, labor may be induced to avoid serious complications. Antibiotics will be started to prevent infection.

Cervical incompetence (cervical insufficiency)

This condition is known as cervical incompetence, or cervical insufficiency. While it’s an uncommon condition, it can cause serious complications.

Women are at a higher risk for cervical incompetence if they’ve had:

a previous cervical trauma, such as a tear during delivery
a cervical cone biopsy
other operation on the cervix

Symptoms

Unlike preterm labor, cervical incompetence typically doesn’t cause pain or contractions. There may be vaginal bleeding or discharge.

Treatment

In other cases, when the membranes have already ruptured and the fetus is old enough to survive, your doctor will likely induce labor.

Prevention

Preeclampsia

Preeclampsia occurs when you develop:

high blood pressure
proteinuria (a large amount of protein in the urine)
excessive edema (swelling)

Preeclampsia affects every system in the body, including the placenta.

Symptoms

Symptoms of preeclampsia include rapid swelling of your legs, hands, or face. Call your doctor right away if you experience this type of swelling or any of the following symptoms:

headache that doesn’t go away after taking acetaminophen (Tylenol)
loss of vision
“floaters” in your eye (specks or spots in your vision)
severe pain on your right side or in your stomach area
easy bruising

Injury

You’re more prone to injury during pregnancy. Your center of gravity changes when you’re pregnant, which means it’s easier to lose your balance.

Outlook

Last medically reviewed on December 3, 2018

Parenthood
Pregnancy
2nd Trimester

How we reviewed this article:

Get the full 40 weeks of pregnancy. (n.d.).
health5mom.org/wp-content/uploads/2015/03/Go-The-Full-40-Implementation-Toolkit_2015-1.pdf
March of Dimes. (2015). Cervical insufficiency and short cervix.
marchofdimes.org/complications/cervical-insufficiency-and-short-cervix.aspx
March of Dimes. (2017). Miscarriage.
marchofdimes.org/complications/miscarriage.aspx
Mayo Clinic Staff. (2018). Preeclampsia.
mayoclinic.org/diseases-conditions/preeclampsia/basics/definition/con-20031644
Moldenhauer J. S. (2018). Premature rupture of membranes (PROM).
merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-complications-of-labor-and-delivery/premature-rupture-of-membranes-prom
Rundell K, et al. (2017). Preterm labor: Prevention and management.
aafp.org/afp/2017/0315/p366.html
WomensHealth.gov. (2018). Pregnancy complications.
womenshealth.gov/pregnancy/youre-pregnant-now-what/pregnancy-complications

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

Current Version

Dec 3, 2018

Written By

April Kahn

Edited By

Nizam Khan (TechSpace)

Medically Reviewed By

Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT

Share this article

Medically reviewed by Debra Rose Wilson, Ph. D., MSN, R.N., IBCLC, AHN-BC, CHT — By April Kahn on December 3, 2018

Warning signs during pregnancy - CGP on REM city polyclinic No. 11

We discuss the most pressing issues of pregnancy management in the classroom at the Young Mother's School and invite our women to an active constructive dialogue.

Schools are held in the format of an interactive conversation, we invite you to ask questions to the doctor, get comprehensive advice on planning and managing pregnancy, contraception and women's health. Our obstetrician-gynecologists are ready to do everything possible for a comfortable pregnancy, however, we hardly get feedback from our women.

Ladies, Women's Health Schools are held every Thursday from 13.00 to 14.00.

First trimester warning signs that require medical attention:

vomiting more than 8-10 times a day
bleeding from the genital tract
severe pain in the abdomen or side.
The pain may be dull at first and then begins to increase.

Physiological changes during pregnancy that do not require special treatment:

nausea
change of taste
appearance or darkening of pigment spots on the skin
soreness of the mammary glands.

There are three trimesters during pregnancy. The first trimester corresponds to the first three months of pregnancy, the second - the period from 4 to 6 months of pregnancy,

Signs that require immediate medical attention in the second trimester of pregnancy:

persistent or severe headache
blurred vision or flickering of dark dots ("flies") before the eyes
noticeable or sudden onset and rapidly increasing edema
bleeding from the genital tract
severe persistent abdominal pain
persistent vomiting
no fetal movement within 24 hours
profuse watery vaginal discharge (amniotic fluid rupture)

You should know and seek immediate medical attention if you develop any of the following symptoms in the third trimester of pregnancy:

bleeding from the genital tract
profuse watery vaginal discharge (amniotic fluid discharge)
persistent or severe headache
blurred vision or flickering of dark dots ("flies") before the eyes
fever up to 38C or more
severe abdominal pain
weakening or absence of fetal movements
contractions at intervals of 5-10 minutes.

Signs that urgently need to seek medical attention in the postpartum period:

profuse bleeding (you have to change several pads per hour), bright red or with clots
purulent, foul-smelling discharge from the genital tract, severe pain in the lower abdomen
increase in body temperature up to 38 C or more
soreness, discharge in the area of the postoperative suture on the anterior abdominal wall or in the perineum
engorgement, soreness, redness of the mammary glands.

#gynecologist #GP11 #obstetrician_gynecologist #health_school #pregnancy #pregnancy_alarm signs #symptoms

Second trimester of pregnancy (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.