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The second trimester is referred to as the honeymoon phase of pregnancy because typically nausea improves and patients feel more energetic compared to their first trimester.
At this stage, the baby is growing in size with all its organs and systems beginning to take shape. During this phase, HCG levels drop (1) and the placenta takes over the growth of the baby, thus reducing the instances of severe nausea and fatigue in the mother.
In fact, many women feel that they can return to their previous activities with more energy. This trimester is also when women first feel fetal movement and, therefore, is a very exciting time.
Finally, anatomy ultrasound is also performed in this trimester to look at the appropriate growth of the baby and development of essential organs and body parts. Sometimes, gender is revealed as well. All of these are very exciting for women.
Duration of the Second Trimester
The second trimester may last from week 14 to week 27 plus 6 days.
Anatomical Changes During the Second Trimester of Pregnancy
For the woman, the uterus begins to rise out of the pelvic brim toward the end of the second trimester, making the pregnancy more visible. (2)
She continues to have an expanded blood volume, whereby her heart is pumping more blood per minute than before pregnancy, with about one-fifth of the entire maternal blood supply now going to the uterus. (2)
Problems Associated With the Second Trimester of Pregnancy
Pregnant women often experience the following discomforts during the second trimester:
1. Round ligament pain
Round ligament pain can be a common concern in the second trimester (3) as the uterus is starting to grow much more than in the first trimester.
The round ligaments attach the uterus to the pelvic side wall and then ultimately through the inguinal canal to the labia majora. This is why many patients have bilateral lower pelvic pain/stretch (4) in this region.
Stretching, Tylenol, and physical activity are recommended for improvement. Some women use heat packs as long it is not directly over the uterus.
2. Experiencing fetal movement
Though not a problem, women first experience fetal movement in the second trimester, which can sometimes be confused with gastrointestinal movement, uterine cramping, etc.
3. Nausea and vomiting
Nausea and vomiting, though improving, can still be challenging in the second trimester of pregnancy, which may require a change in dietary habits and medications to treat.
Some women will experience more constipation as gastrointestinal motility slows with the pregnancy hormones circulating throughout the body. (5) It is therefore important to overhydrate, increase the intake of green leafy vegetables with fiber, and continue to eat fruits, which also have fiber.
Some women may need additional stool softeners or fiber bulking agents that are safer in pregnancy. (5)
5. Gum swelling
Pregnant women may experience some degree of gum swelling during the second trimester, but unprovoked bleeding typically does not occur without an underlying coagulopathy. So, if your gums start to bleed for no reason, visit your doctor for a checkup.
6. Painless cervical dilation and a preterm previable vaginal delivery
In very rare instances, patients with cervical insufficiency can have painless cervical dilation and a preterm previable vaginal delivery, which would be the most complex complication in the second trimester. (6)(7)
Relief During the Second Trimester
Nausea and severe fatigue typically improve in the second trimester. First-trimester spotting (8) also improves in this stage.
Cramping During the Second Trimester of Pregnancy
It is normal to experience uterine stretching and round ligament pain in this stage. However, cramping, although not uncommon, is not typically seen in the second trimester.
As the baby begins to move, the mother may experience a uterine cramp in response to the baby’s kicks, which may be described as a reactionary “tightness” by patients. However, this is not what is typically meant by uterine cramping.
Vitamins and Mineral Supplements to Take During the Second Trimester
Women should continue to take their prenatal vitamins daily, and they may need an iron supplement if their blood work has found iron deficiency anemia. (9)
Exercises Recommended for the Second Trimester of Pregnancy
There are no restrictions on exercise in the second trimester as long as the woman is not involved in contact sports, which can cause direct injury to the abdomen, and as long as she feels comfortable with the exercises.
I always recommend for women to stay overhydrated during their exercises and to listen to their bodies when they tell them to stop, while taking plenty of breaks. It is still fine to swim, jog, bike, lift weights, and do cardio classes or workout machines during pregnancy.
When the center of gravity changes due to the enlarging abdomen, (10) women tend to then scale back on some of their physical activities due to balance, such as biking. Exercise throughout pregnancy, however, is very healthy and encouraged. (11)
Every woman is built differently, which affects how she conceives, carries, and delivers a baby. Thus, the whole pregnancy experience cannot be generalized since every woman may have her own health concerns and risk factors. However, the standard course of the pregnancy remains the same for all women: a 9-month process divided into 3 trimesters of 3 months each.
The second trimester is relatively less discomforting than the first one but is marked by significant fetal development and some degree of unease.
A few simple home care measures can help you ride through this phase with no difficulty. This includes appropriate exercises, hydration, stretching, a well-balanced diet, and getting appropriate amounts of sleep.
Make sure to consult your ob-gyn before trying any new intervention and if you are facing constant discomfort or notice anything out of the ordinary.