Second Trimester: What You Need to Know

As your body changes in the second trimester, find out which symptoms are normal and which need a medical professional’s attention.

Abdominal Cramping

One way to ease round ligament pain in pregnancy is with a warm bath.

Abdominal cramping in pregnancy and pain is fairly normal, since your body is experiencing a lot of changes. These are often associated with constipation to Braxton-Hicks contractions or round ligament pain in the second and third trimesters. Sometimes, it could be a sign of urinary tract infection, preeclampsia or miscarriage.

Call your doctor if: you have cramping, just to be safe. Monitor any other symptoms like fever or chills, spotting or bleeding, severe headaches, vision changes, pain, burning, or difficulty urinating. Other symptoms to watch out for are dizziness or feeling faint, and more than four contractions in one hour. If gas-related pain comes and goes every few minutes, call your doctor as these could be labour pains.

Braxton Hicks

What it is: These occur as the womb contracts and relaxes. It may feel like mild menstrual cramps, or a specific area of your stomach tightening which comes and goes. Compared to labour pains, these are of varying strengths and lengths, are unpredictable and do not follow a rhythm.

Why do I have it? Some reasons for these contractions include being very active or dehydrated and having a full bladder or sex.

Treat this: Simply change position, lie down and have a nap, walk around if you’ve been sitting for a while. Also, drink water and relax.

Call your OB-GYN if: you have vaginal bleeding, your waters break or the pain intensifies. Other signs include having strong contractions every five minutes, lasting 30 - 60 seconds, or if you have any concerns about your baby’s movements.

Round Ligament Pain

What it is: As your round ligament stretches and contracts, it causes a sharp pain or jabbing feeling in the lower belly or groin area. This could be on either side or both and is usually most often felt during the second trimester.

Why do I have it? The round ligament, which connects the front area of the womb to your groin, stretches and makes it more likely to become strained.

Treat this: After checking with your doctor, take some pregnancy-safe pain relief. Other ways include stretching exercises or prenatal yoga. Change positions slowly, avoid sudden movements and flex your hips. Modify your daily activity levels, and apply warmth with a heating pad or have a warm bath.

Call your OB-GYN if: you have severe pain, especially lasting for more than a few minutes, chills, fever, pee on urination or difficulty walking. Your doctor can rule out more serious conditions like placenta abruption, inguinal hernia or stomach, liver and kidney problems.

Baby Movements

Your baby starts moving in the womb at 24 weeks.

What it is: At 24 weeks, you can feel your baby moving in the womb. It may feel like a flutter, kick, roll or swish and may change as your pregnancy progresses. Every baby is different, so it’s important to know how your baby moves.

What you should know: Babies should move more and more from 18-24 weeks, and after 32 weeks, or about eight months, the movements should be about the same until you give birth.

Treat this: Do not try to use a doppler or try to get your baby to move. Avoid using dopplers, handheld monitors or phone apps to check your baby’s heartbeat.

Call a doctor immediately if: your baby moves less, doesn’t move by 24 weeks or a difference in movement. This can be a sign that your baby is unwell. You’ll have a full antenatal checkup, ultrasound scan and a cardiotocograph monitor. Most women who have experienced an episode of fewer movements do have a healthy baby, but it’s vital to ensure that everything is okay.

Bleeding

Sleep on your side if you experience any rectal bleeding.

Vaginal Bleeding

What it is: Usually, light bleeding or spotting (red, brown or pink) during the second and third trimester is fairly common. Similarly, pink mucus or brownish discharge is also normal, as small amounts leave your body with discharge.

Why do I have it? Light bleeding or spotting is typically caused by cervix interference during sex or a vaginal exam.

Treat this: For light bleeding, it should go away within a day or two. For heavier bleeding, call your OB-GYN and he/she will treat it accordingly.

Call your doctor if: you have vaginal bleeding that resembles a period, with blood clots or clumps or tissue. Make the call immediately if the bleeding is heavy, or if it’s paired with pain. Serious bleeding is likely caused by placenta previa - when the baby’s placenta partially or completely covers the cervix - premature labour, or a late miscarriage.

Rectal bleeding

What it is: Generally, rectal bleeding is a sign of either hemorrhoids or anal fissure.

In particular, up to half of all pregnant women suffer from hemorrhoids, which can be painful, itchy or cause bleeding. All these symptoms are made worse by constipation. Another cause of rectal bleeding might be anal fissues, which is a crack in the skin lining the anal canals. These are very painful, especially when having a bowel movement.

Why do I have it? Progesterone acts on the walls of the rectal veins, where they relax and expand. As your pregnancy progresses, the uterus presses further on these veins, slowing down blood flow and dilating the veins more. Meanwhile, anal fissures are usually caused by constipation.

Treat this: Drink loads of fluid and eat high-fibre food. Sleep on your side, avoid standing or sitting for too long, and don’t take too long or strain when going to the bathroom. Take warm sitz baths twice a day, soothe the hemorrhoids with ice packs or witch hazel. Your doctor might prescribe stool softeners, a laxative or topical medications.

Call your doctor if: you have heavy or continuous bleeding. Hemerrhoids and anal fissures cause brown, pink or red bloodstains. Massive rectal bleeding could also be caused by ectopic pregnancies or serious internal problems. If you’re experiencing heavy bleeds, call your OB-GYN immediately.

Nosebleeds, Nasal Congestion and Gum Bleeding

What it is: In the second trimester of pregnancy, you may also have nasal stuffiness or nosebleeds.

Why do I have it? As estrogen and progesterone levels increase, these hormones cause increased blood flow, and the blood vessels in the mucus membranes swell. This may also apply to your sensitive gums, so use a softer toothbrush.

Treat this: Use a humidifier to help with the dryness, and blow your nose gently. For nosebleeds, lean forward and apply gentle pressure for five minutes.

Call your doctor if: the bleeding doesn’t stop, or is heavy and frequent. Definitely seek emergency medical care if nasal congestion makes it difficult to breathe. Additionally, visit a dentist if you bleed a lot when flossing or brushing your teeth, as this can be a sign of health concerns that may complicate pregnancy.

Digestive Issues

Eat loads of fiber-rich whole grains like oats to keep things moving.

Constipation

What it is: Irregular bowel movements that lead you to feel bloated or gassy.

Why do I have it? Pregnancy hormones! The increased levels of progesterone makes your bowel muscles relax, and food gets to hang around longer in your digestive tract. This is beneficial for the baby since the nutrients can be absorbed into your bloodstream and reach your baby.

Treat this: Aim to get 25 to 35g of fiber-rich foods per day. Eat plenty of whole grains, legumes, fresh fruits and veggies, across six mini-meals. Additionally, drink loads of fluids, don’t hold in your bowels, and add probiotics to your diet. Walking also helps regulate bowel movements.

Call a doctor if: your supplements might be causing you constipation, so you can find better alternatives that work for you.

Diarrhea

What it is: Loose stools that cause you to keep running to the toilet.

Why do I have it? Some reasons include healthy lifestyle changes like diet, or prenatal vitamins. Others include food poisoning, intestinal parasites or a stomach flu.

Treat this: Adopt a gentle diet including bananas, rice, applesauce and toast. Other great options include starchy food, cooked vegetables, non-milk-based soups, lean meats, cooked eggs, and yoghurt with live, active cultures. Avoid foods that will exacerbate the problem. These include dried fruits, fatty or spicy foods and milk if you’re lactose intolerant.

Call a doctor if: you have severe diarrhea or diarrhea that lasts more than two days. Other serious symptoms include bloody or liquid stools, or those containing mucus. Once you’ve got diarrhea, it’s worth calling your doctor anyway to get checked for any infections, as well as getting appropriate medication.

Heartburn

What it is: As the lower esophageal sphincter (LES) begins to relax, so stomach acids flow upward into the oesophagus. Heartburn often occurs in about 50 per cent of pregnancies in the second and third trimesters, commonly after meals or at bedtime. It can feel very uncomfortable and even agonising.

Why do I have it? While the relaxin hormone focuses on limbering your joints and connective tissue for an easier delivery, it also slows your digestion. Therefore, food stays in your stomach longer and triggers increased acid production. Meanwhile, your growing baby also puts pressure on the stomach and LES, so acids will likely be pushed up the oesophagus.

Treat this: Eat smaller meals more frequently, to aid digestion and relieve heartburn symptoms. Eliminate trigger foods from your diet. Instead, try more liquid-based foods like soups, smoothies, and puddings. Stop eating three hours before bedtime, and elevate your head when sleeping.

Call a doctor if: your symptoms don’t abate with diet changes or pregnancy-safe antacids. Check if your heartburn symptoms are paired with headaches or swelling in your hands and face. Heartburn-like pain could also be a symptom of preeclampsia, so monitor your blood pressure as well.

Incompetent Cervix

During your pregnancy, the ideal amount of weight gain is about 11 to 16 kg.

What it is: An incompetent cervix is when the weak cervical tube contributes to premature birth or pregnancy loss. In this instance, the cervix may soften and open too soon. Risk factors might include cervical trauma, race, and congenital conditions.

Treat this: Your doctor might recommend preventative medication, frequent ultrasound or closing the cervix with strong sutures.

Prevent it: Ways to try prevent it include seeking regular prenatal care, eating healthily - with more folic acid, calcium, iron and prenatal vitamins if necessary. Moreover, gain about 11 to 16kg during your pregnancy. As with the other conditions, quit smoking, don’t drink alcohol or take illegal drugs. Finally, get your doctor’s approval before taking any medication or supplement.

Call a doctor if: you have mild discomfort, spotting over the course of several days or weeks during the 14 and 20 weeks of pregnancy. Other concerning symptoms include pelvic pressure, backache, mild abdominal cramps, vaginal discharge changes, and light bleeding.

Leg Cramps

Time to trade in the stilettos for comfortable, supportive shoes or sandals.

What it is: Leg cramps are fairly common in the second and third trimester.

Why do I have it? Potential reasons include a lack of calcium, too much phosphorus in your diet, or are tired. Another cause is that the uterus is pressing on the nerves to the legs. Hence, you may get bothersome cramps in the middle of the night.

Prevent it: Be sure to exercise your calves, staying hydrated as usual, wearing support hose and comfortable, supportive shoes, and flexing the ankle and toes upward.

Treat this: With your doctor’s approval, reduce the amount of phosphorus in your diet and ensure you get enough calcium and magnesium.

Call your doctor if: the cramps feel super painful, don’t go away, cause swelling, feel warm to the touch, or if your leg’s colour changes to white, red or blue. You may have a blood clot in a leg vein.

Preeclampsia

Once you know you’re pregnant, make sure to go for regular prenatal checkups.

What it is: Characterised by high blood pressure and signs of damage to another organ system, such as the liver and kidneys, preeclampsia usually starts after 20 weeks of pregnancy.

Why do I have it? Some causes might include narrower blood vessels that may not develop or function properly. Others include genetic factors, blood vessel damage and insufficient blood flow to the uterus. Additionally, risk factors include a personal or family history of preeclampsia, your first pregnancy, chronic hypertension, age, obesity, and multiples.

Prevent it: Mums can take low-dose aspirins. Ensure you’re as healthy as possible and manage any existing conditions. Go for early and regular prenatal care, so your doctor can detect preeclampsia early and work together to prevent complications.

Treat this: Delivering your baby will treat the condition, however you and your baby may be at risk of serious complications if it’s too early.

Call a doctor if: you have severe headaches, vision changes, or pain under your right side ribs. Other signs include sudden weight gain and swelling, nausea or vomiting, shortness of breath, and decreased urine output. Also, high blood pressure above 140/90 milliliters of mercury (mmHg) on two occasions for hours apart is abnormal.

Preterm Labour

In Singapore, one in 11 babies are born prematurely.

What it is: Preterm labour may result in premature birth, which in turn may increase your baby’s health risks and need special care in the neonatal intensive care unit. In Singapore, one in 11 babies are born prematurely.

Why do I have it? Risk factors include previous preterm labour or premature birth, a pregnancy with multiples, uterus or placenta problems, or too much amniotic fluid. Women under 24 or above 35 years old are also at a higher risk for preterm labour. Other considerations are multiples with Assisted Reproduction Therapies and pregnancy spacing more than 6 months but less than 59 months of age.

Prevent it: Get regular prenatal care to monitor both your baby’s and your health. Next, increase your intake or nuts, seeds, fish and seed oils to help lower the risk of premature birth. Ensure you’re managing your chronic conditions well, and quit all illicit drugs and smoking.

Call a doctor if: If you have regular contractions that result in your cervix opening between week 20 and 37 of your pregnancy, you may have preterm labour. Other symptoms include a constant, dull backache, pelvic or lower abdominal pressure or cramps, vaginal spotting or light bleeding. You could also experience a gush or continuous trickle of fluid from your vagina, or if your discharge changes to watery, mucus-like or bloody.

Preterm Premature Rupture of Membranes

What it is: Should the amniotic membrane surrounding your baby break before week 37, you’ll have an increased risk for infection as well as having your baby born early. Other complications of PPROM include the placenta separating from the uterus and umbilical cord problems.

Why do I have it? As above, the risk of PPROM heightens with a preterm birth in a previous pregnancy, an infection in the reproductive system, vaginal bleeding and smoking during pregnancy.

Prevent it: To prevent PPROM, try to take good care of yourself, visiting your healthcare provider as soon as you’re pregnant, and keep up with your prenatal checkups. Of course, quit smoking.

Treat this: At your visit to your healthcare provider, he/she will do an exam, with a speculum to look and then test the fluid. Your doctor will then administer the proper treatment, such as medicine, hospital stay and bed rest, or inducing labour.

Call a doctor if: you experience a sudden gush and leaking of fluid from your vagina

Skin Changes

The darkened line down your abdomen is one example of skin changes during pregnancy.

What these are: An increase in pigment-bearing cells in your skin, creating brown patches on your face, known as melasma. There might be a dark line down your abdomen (linea nigra) or reddish-brown, black, silver, or purple lines along the abdomen, breasts, buttocks, or thighs, i.e., stretch marks.

Why do I have it? Hormonal changes during pregnancy. These usually fade after delivery.

Treat this: While these will fade only after delivery, use sunscreen when outdoors. You can treat stretch marks with oils, creams, staying hydrated and moisturised, and exercising to improve skin and muscle tone.

Call a doctor if: you develop any new moles, rashes, spots or markings that concern you. Only two skin changes are cause for concern, such as blisters on the abdomen that spreads to large parts of the body. Known as pemphigoid gestationis, it may increase the risk of complications, including preterm birth. If you have itching on your palms and soles, you may have a liver condition known as intrahepatic cholestasis of pregnancy.

Related Reads: Some of these pregnancy essentials may help relieve your symptoms. The second trimester is also a good time to start adding items to your birth registry.

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