Now that you’re in the Second Trimester, your prenatal appointments will become shorter, only about 15 minutes each. These visits will begin like any other, with your healthcare provider checking your weight and blood pressure to make sure that all is progressing smoothly.
2nd Trimester, 1st Appointment (Week 16)
Your healthcare provider will probably measure the height of your uterus, which can very much help to determine how big Baby is growing. Your healthcare provider will also listen to their heart rate with a fetal doppler. In addition, if you did not undergo any screening at your last appointment, your healthcare provider may recommend that you take a test like the quad screen, which can identify possible cases of chromosomal, or other developmental abnormalities. The quad screen tests the blood for the following substances:
- Alpha-fetoprotein (AFP): Produced by the fetus, AFP is a protein that when found in excessive amounts can indicate a neural tube disorder like Spina Bifida, and in deficient amounts, a chromosomal abnormality (Down Syndrome, Edwards Syndrome).
- Human Chorionic Gonadotrophin (hCG): A hormone produced by the placenta, abnormal levels of hCG can indicate a chromosomal disorder like Down Syndrome or Edwards Syndrome.
- Estriol: Produced by both Baby and placenta, abnormal levels of estriol can indicate a chromosomal disorder.
- Inhibin-A: A protein produced by both Baby and you, high levels of which can indicate a chromosomal abnormality.
If any of these readings comes back irregular, your healthcare provider may refer you for an amniocentesis (based on your overall risks), a diagnostic test performed between weeks 16-20 that samples your amniotic fluid for more conclusive results about any chromosomal abnormalities. The amniocentesis is an invasive procedure, and involves a small risk of miscarriage (1 out of every 400 or so), so it is usually only recommended for women whose early tests display a positive marker, or who are over the age of 35.
Your healthcare provider may also have you schedule your 20-week ultrasound at this time, which is often immediately before your next prenatal visit. However, those who are overweight may have this ultrasound pushed back a couple of weeks.
2nd Trimester, 2nd Appointment (Week 20)
Many women will schedule their 20-week ultrasound around this prenatal visit, and those who do should expect this appointment to run a bit longer than most, usually about an hour. This ultrasound is a complete fetal profile, and looks at the face, hands, feet, abdomen, extremities, spine, heart, and thorax. If you do get an ultrasound right before meeting with the healthcare provider, this is what the healthcare provider or ultrasound technician will be looking for:
- Boy or Girl: If you wish to know, your ultrasound technician will be able to tell you at this time whether you are having a son or a daughter. Just remember to be clear about whether or not you want to know, before they coat your belly in jelly.
- Placental Location: The placenta often covers the cervix in early pregnancy, but it is supposed to move up as gestation progresses, providing an open pathway for Baby to crawl out of. If the placenta is covered, a condition known as placenta previa, you’ll be given another ultrasound in the third trimester to see if the problem has resolved on its own, which is the case for most instances of second trimester placenta previa. If it has not, a C-section is probably necessary.
- Baby’s Size: The ultrasound technician will take Baby’s measurements to make sure that they are growing at the rate they should be, according to the due date. If they are too large or too small relative to the projected due date, it may be revised one way or another.
- Amniotic Fluid: Your healthcare provider or the ultrasound technician will check how much amniotic fluid Baby is floating in, as too much or too little can be a problem.
As always, your healthcare provider will take your weight, blood pressure, and have you leave a urine sample, which they will test for high levels of protein and sugar. Testing for protein is now especially important, because week 20 marks the beginning of the risk of what healthcare providers call “preeclampsia”, characterized by an excess of protein in urine and high blood pressure. Your healthcare provider will also take Baby’s heart rate with a fetal doppler, an exercise that will become a part of the pre-natal visit routine.
2nd Trimester, 3rd Appointment (Week 24)
Like always, your healthcare provider will take your blood pressure, weight, and have you leave a urine sample, which they will test for elevated levels of sugar and protein, indicators of gestational diabetes and preeclampsia, respectively. The healthcare provider will also check Baby’s heart rate with a fetal doppler, just to make sure everything is going smoothly.
In addition, your healthcare provider may have you take a glucose screening test that can determine your risk of developing gestational diabetes. Once at the office, you’ll be asked to drink a cold, sugary substance containing 50 grams of glucose within five minutes. Following this, your healthcare provider will have you wait for an hour while the glucose seeps into your blood, to see how efficiently your body is able to process sugar. Once the hour has passed, your blood will be drawn, and this efficiency measured. These results will become available by your next appointment. A measurement that is too high (meaning you cannot process glucose efficiently) does not necessarily conclusively point to gestational diabetes, rather, if your reading lies outside of the safe zone your healthcare provider will have you take a longer, more comprehensive, and more confident Glucose Tolerance Test, which will assuredly confirm or deny the development of gestational diabetes.
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Sources
- Sir John Dewhurst. Dewhurst’s Textbook of Obstetrics and Gynaecology. 8th ed. Keith Edmonds. John Wiley and Sons Ltd, 2012. Print.
- Mayo Clinic Staff. “Second trimester pregnancy: What to expect.” Mayo Clinic. Mayo Clinic, 5/15/2014. Web.
- “Body changes and discomforts.” Womenshealth.gov. U.S. Department of Health & Human Services, 9/27/2010. Web.
- “Preterm labor.” March of Dimes. March of Dimes, n.d. Web.
