Second Trimester – Answered by David Priver, MD, FACOG

Q. I am 25 weeks’ pregnant and have been feeling strong fetal movement from what feels like near my cervix. I have been feeling FM for over ten weeks but never this low. Should I be worried?

A. There is no reason to be worried. As your pregnancy progresses and the baby grows, you’ll feel the kicking in different locations as the baby changes position.

Q. When I sit down, no matter when or where, I feel pressure right above my pelvic bone. I am only 25 weeks, so I’m very concerned.

A. This is not a matter for concern. By sitting down, you bring the uterus into contact with the back side of the pubic bone. This area has the potential to stretch beginning in the second trimester, which ultimately provides for more room for a baby to descend during labor. It is this stretching that you are feeling, and this improves your chances for a normal birth.

Q. I am 25 weeks’ pregnant, and my cervix is 1.3 cm. I’m also having a slight lack of blood flow through the cord. What are the chances I will make it to term, and what can be done besides bed rest, prometrium and betmethasone?

A. Probably not that good, given the parameters you describe. That said, however, if you can get past 28 weeks the chances for an acceptable outcome are reasonably good, given the fantastic strides that have been made in neonatal care in the past couple of decades. It sounds like you are getting excellent care at this point. Just continue to have a low threshold for going into the hospital if you begin to detect contractions and/or a decrease in your baby’s kicking activity. This will give your doctors a better chance of preventing premature birth.

Q. I am 26 weeks’ pregnant. Every morning when I wake up, my belly seems to have decreased in size. What could this mean?

A. Certainly, it’s not a sign that anything’s wrong with the pregnancy or with you. The most likely explanation is that what you’re seeing is a reduction in the size of your stomach as a result of digestion which has occurred in the 10 or 12 hours since you last had anything to eat. During the day, your uterus presses your full stomach upwards, but by the next morning, most of that fullness is gone.

Q. I am 17 weeks’ pregnant. Since I was about 14 weeks’ along I have felt a knot when I press on the lower right side of my stomach. It seems to move slightly at times and does not hurt. Sometimes it seems as though it is different sizes. They say it could be the baby, a hernia or a mass, which really scares me. What do you think it could be? Is this normal?

A. Most likely, you are feeling the top of your uterus. It is not uncommon for the uterus to lean to one side or the other. While it’s most unlikely that this is a cause for concern, you should mention it at your next prenatal visit.

Q. I’m 19 weeks’ pregnant, my doctor said it looks like my placenta is breaking off. Today I woke up and had bad pain on the lower right side and there was spotting on my underwear but no blood. What should I do?

A. If you remain at rest, there’s a good chance that this will resolve on its own. However, placental abruption, as this is called, is potentially dangerous, so you need to watch closely for increasing bleeding or abdominal pain.

Q. I’m 16 weeks’ pregnant and my three-year-old kicked me hard with the back of her heel below the belly button and I would just like to know if the baby is ok. Is there anything I could do, and what are the chances that the baby was kicked in the face?

A. It is almost unheard of for this sort of event to cause any problems with the baby as it is extremely well protected by amniotic fluid. In the unlikely event that something dangerous has happened, it is essentially certain that your water would have broken or bleeding would have happened. If you’re still worried about this (and it is, after all, a mother’s job to worry about her children), you can have your doctor’s office listen for the heartbeat.

Q. I am 19 weeks’ pregnant with my first baby and during a Pap smear my doctor said my cervix was irritated. It was also very painful during the exam. He also said I have a tipped uterus. Is this why it was so painful and what causes your cervix to be irritated?

A. What your doctor likely meant was that your cervix is reddened. What this means is simply that the hormonal changes of pregnancy have caused the part of the cervix that is normally confined within the cervical canal, to grow out onto the visible part of the cervix, a process we call eversion. It is normal and harmless and would not cause pain. A tipped uterus is not unusual, but, in most cases, it should be starting to straighten out by now. Your doctor will want to be sure that happens in the next three to four weeks, as there are some rare but serious implications of an advancing pregnancy with the uterus “trapped” in that position.

Q. I went for my 20-week sonogram yesterday and my doctor told me that they were unable to confirm that the baby had four chambers in the heart. She said it was due to the position of the baby and I was fine with that until she asked if we would terminate the pregnancy if there was something wrong. This is my fourth baby and I have NEVER had them say they couldn’t confirm proper heart development at 20 weeks. Baby is growing right on schedule and her heart rate was 154. Should I be concerned, or is this common?

A. Fetal position does have a big impact on the ability to see small items like heart chambers. Another sonogram in a week or two should be able to resolve this fairly common issue.

Q. I’m 15 weeks’ pregnant and I did not miss a period. I went to the doctor today and was told that my cervix has dilated 2 cm and I probably am having a miscarriage. What can I expect?

A. This could be an urgent situation. When the cervix dilates painlessly in the second trimester, that is a condition called an “incompetent cervix.” If it is detected in time, a suture can be placed around the cervix so as to hold the pregnancy until term, at which time it is removed to permit labor and birth. If the information you are providing is correct, this matter needs to be discussed ASAP with your OB.

Q. I’m 21 weeks’ pregnant, and my doctor said that my cervix is opened just a tiny bit and that it’s normal for it to be not completeley closed if you have had kids before. Is this true?

A. This is completely true, and, for that reason, there is no purpose served by examining your cervix in the absence of abnormal symptoms.

Q. I’m 18 weeks’ pregnant with my second child. Three days ago I noticed a gaslike pain under my left rib cage. I thought it would subside, but it hasn’t and is quite painful and annoying. I’ve had two bowel movements since then and the pressure or pain has not gone away. I’ve tried carbonated beverages to assist the gas in making its way out, but that hasn’t helped. I’ve had blood in my stool maybe once a week since I’ve been pregnant, and am wondering if the two could be related or if I might have an ulcer or if this is just a painful gas bubble.

A. This sounds quite suspicious for a digestive condition called acid reflux, which is fairly common in pregnancy. It is usually quite easy to treat nowadays. It is a nuisance, but not dangerous. Bring it to your doctor’s attention at your next OB visit.

Q. At my 21-week scan, my baby’s head was tilting back. The midwife said the scan showed nothing abnormal, but why is my baby tilting his head back in my womb?

A. There is nothing any more abnormal about a baby tilting its head back than for you to do so. Remember that a sonogram is just a momentary view during which a fetus can assume any position.

Q. I am 22 weeks, 5 days’ pregnant. The doctor’s office told me my belly measured too big, and they are going to send me for an ultrasound. What could this mean?

A. In most cases, it doesn’t mean anything as there is quite a lot of individual variation among pregnant women. If you’ve not yet had an earlier ultrasound, then the possibility exists that your dates are inaccurate or that you might have twins. Very rarely, there exists an excessive amount of amniotic fluid, which can be a sign of a fetal abnormality.

Q. I am 23 weeks’ pregnant, and my baby’s head is at 60 percent. Is that normal?

A. Yes, it is. This just means that your baby’s head measurements are in the 60th percentile; in other words, very slightly larger than average, but certainly not reflecting anything abnormal.

Q. I’m 22/23 weeks’ pregnant, with moderate hip, lower-back, stomach and pelvic pain and liquid leaking every time I get up. Should I be worried?

A. Yes, you should. Fluid leaking from the vagina means that the membranes have ruptured until proven otherwise. This raises a number of serious dangers, including infection and premature birth. Be sure your doctor is notified immediately about these symptoms.

Q. I am 23 weeks and having a boy. I went to the doctor yesterday and they are concerned because my baby’s abdomen was two weeks behind in growth. What does this mean? Is there something wrong?

A. As an isolated finding, it doesn’t mean a thing. At 23 weeks, a two-week discrepancy is fairly minor. Undoubtedly, the matter will be explored further in weeks to come, but the risk of a fetal abnormality in this circumstance would be small.

Q. I’m 24 weeks’ pregnant, my ob/gyn said that my amniotic fluid is too high. What does it means? Should I be worried?

A. Excessive amniotic fluid is a potential danger sign of fetal maldevelopment and needs to be carefully followed. That said, amniotic fluid volumes are subject to frequent and harmless shifts. I would suggest that a high resolution ultrasound be considered so as to evaluate both the intestinal and urinary systems, which would be the main areas of concern.

Q. I’m 22 weeks pregnant. At my first ultrasound they found my cervix 1 cm dilated, and my water bag visible. The ob suggested a cerclage. I declined because of the risk of rupturing the water bag. I went to another hospital for an alternative and they told me about a pessary, which was not painful at all, so I went for it. I feel like it’s taking the pressure off my pelvic area but the cerclage was still recommended. When I stand up I feel some mucus come out, but there’s no leaking fluid down my legs and no blood. Will everything be ok?

A. At 22 weeks a visible bag of waters is a clear indication of what we call an incompetent cervix, the only treatment for which is cerclage. A pessary will perhaps make you feel more comfortable, but will not reduce the risk of an extremely premature birth. So, my advice is to have the cerclage. In qualified hands the risk of rupture of membranes should not be more than around 5%.

Q. I am 18 weeks’ pregnant. I went for an ultrasound this week, and my doctor told me that my baby had dilated kidneys. The next appointment I have been given is 32 weeks. I am assuming that after this find the doctor would want to see me a little more often. I am worried about the baby’s condition and I don’t want to have amniocentesis due to chances of miscarriage. I would like to know if I need to worry both about my baby and the doctor not wanting to see me frequently. Thank you.

A. I’m concerned as well. Prenatal appointments are never supposed to be less than every four weeks. In this situation, I’d want to get another ultrasound by 24 weeks at the latest. By the way, I don’t know if anyone has advised you to have an amniocentesis, but if they do, you really needn’t worry much about miscarriage. It’s extremely rare following that procedure and a lot of important information can be gained by it.

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