What to Expect from Your OB-GYN
Trimester-by-Trimester, Normal and High-Risk Pregnancies
The Second Trimester
The Normal Pregnancy:
The second trimester (weeks 12 to 24) is when most pregnant patients feel their best. The miscarriage scare, cramping, and nausea recede, allowing some time before the third trimester brings its own set of concerns and discomforts. Fundal height and fetal heart tones are recorded each visit, with visit intervals ranging between every two to four weeks, depending on your doctor. Blood pressure, weight, and urine surveillance also continue.
The second trimester is normally a quiet time when the generalities of maternal and fetal health and appropriate fetal growth are observed. A free exchange of questions and answers during your visits addresses those things important to you as a prospective mother, and a caregiver’s particular communicative skills will determine the quality of your education as it pertains to your particular pregnancy.
Between 15 and 20 weeks, you should expect to be offered an alpha-fetoprotein (AFP) test to screen for neural tube defects (such as spina bifida) and Down syndrome. If you’re over 35, you will be offered an amniocentesis for genetic studies. (Other genetic studies are available at 10 weeks, such as chorionic villus sampling.)
New and strange pains come and go now as your growing baby competes for space. The baby will win, of course, so shortness of breath, ligament pains, nerve tingling, and other unusual effects occur around this time. Your doctor will begin to look for signs of preterm labor or, if there’s a history of preterm deliveries, incompetent cervix.
Fetal movement, a sign of well-being, usually happens around eighteen weeks. Called “quickening,” the movements become more organized over time, and an obstetrician will be wary of any decreased movement. Problems with movement or appropriate growth will prompt additional ultrasound studies to exonerate the health of your pregnancy.
The High-Risk Pregnancy:
Problems that can make you high risk in the second trimester include:
- The high-risk factors from the first trimester
- Incompetent cervix, increasing the risk of preterm delivery
- Bleeding (due to placental abruption or previa)
- IUGR (Intra-uterine growth restriction–a baby small for the corresponding gestational age
- Gestational diabetes
- Pregnancy-induced hypertension
- Sporadic or non-compliant prenatal care
- Preterm labor
- Kidney infection
- Premature rupture of membranes (or leaking)
- Abdominal tenderness of the uterus (possible infection of the pregnancy)
The Third Trimester
The Normal Pregnancy:
In normal pregnancy, the third trimester is a little longer because there’s a variation in lengths of pregnancies, with “term” considered anywhere from 37 to 42 weeks. A due date is just the middle of the bell curve, and your baby will have his or her own clock, so think of if as your due month.
As you near your due date, a physician or nurse will check your cervix for change—a predictor for how imminent labor is. Some practitioners check as soon as 37 weeks, some not until after the due date.
This is the time for philosophical discussions regarding elective induction, because if there are no medical indications for induction, elective induction should be done only at or after 39 weeks–and you should expect it to be your call. Even though two weeks past the due date is considered the time to act no matter what, extra surveillance should begin right after the due date because your baby keeps growing but the placenta may start dying, and your baby’s needs may outpace the placenta’s ability to deliver.
Non-stress tests and additional ultrasound may be prudent at this time. The third trimester is the time most likely to see pregnancy-related complications of pregnancy-induced hypertension, so signs of this are of the utmost importance. Gestational diabetes is screened for at or around 26 weeks. Group B strep cultures are obtained at around 28 weeks.
The High-Risk Pregnancy:
Problems that can make you high risk in the third trimester include:
- The high-risk factors from the first and second trimesters
- Decreased fetal movement
- Abnormal amount of amniotic fluid
- Emotional abnormalities (pregnancy is a stress that may bring out borderline psychiatric conditions)
- Nausea and/or vomiting—not the typical morning sickness of the first trimester. This late in pregnancy, liver problems may be the cause, from a sneaky PIH variant called HELLP which would prompt immediate delivery to a more benign gallbladder problem which can be addressed after delivery.
- Right upper quadrant pain.
- Decreased “reactivity” on non-stress test, in which the baby’s heart rate does not accelerate after movement, which is the expected norm.
Pregnancy is a condition in which one can be normal one moment and be blindsided by a problem the next. For this reason, every doctor has a routine for keeping an eye out for warning signals in every pregnancy. High-risk patients have a series of appointments tailored just for them. In your visits to your obstetrician, you should expect all of the screenings that this year has to offer—not last year’s obstetrics. You should expect your doctor to follow your pregnancy appropriately, whether you’re high risk or not. And you should expect him or her to know the difference.
YOU MIGHT BE INTERESTED IN