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Sunday, May 14, 2017

Pregnancy - The Second Trimester

Pregnancy is defined as the carrying of one or more offspring, known as fetus or embryo, inside the endometrial lining of a woman. It in generally, can be divided into three trimester periods to prescribe the different stages of prenatal development.
B. The second trimester (week 13- 28)The second trimester also known as golden trimester. As the baby has grow much larger, it can be more easily monitored and diagnosed. Some symptoms of the first trimester has disappear such as morning sickness, but new symptoms will, however, manifest themselves in the second trimester. At this stage, protruding pregnancy belly and the bigger breasts(41) will start to notice by other.
According to WHO, visits for fetal biometry will be scheduled at 14, 18, 24, 28, 32, 36, and 40 weeks (+/- 1 week) to be performed by trained ultrasonographers(40).
B.1. The journey of the baby

1. Week 14-18(42)
a. It is a fastest growing stage, your baby now is about 6 ounces and 8-10 inches long.
b. The umbilical cord will continue to grow and thicken to carry more blood (oxygen) and nourishment to the baby.
c. You may start to feel the movement in your lower abdomen.
d. Etc.

2. Week 19-23(43)
By the end of week 23
a. Your baby will weigh about one pound and be about 12 inches long.
b. You may gain another 3 or 4 pounds.
c. Breathe deeper and more frequently are normal due your bigger belly and more oxygen needed for your baby.
d. The area around your nipples may look darker and wider as your breasts prepare to make milk for your baby
e. Hair begins to grow on his/her head
g. Internal organs are maturing
h. Eyebrows, eyelids and eyelashes appear
i. Etc.

3. Week 24-28(43)
a. Your baby is a fully formed except that the skin is wrinkled and red, because of no fat under the skin.
b. Your baby is now about 14 inches long and weighs approximately 2 ¼ pounds.
c. The baby starts sucking on its thumb and may cry
d. Baby's movement. is now more regularly
e. Eyelids begin to part and eyes open occasionally for short periods of time
f. Skin is covered with protective coating called vernix
g. Etc.

Symptoms
1. Growing belly(44)
In the second trimester the growth and expansion of your uterus (to accommodate your growing baby) is the fastest compared to other trimesters. Your belly start to expand to accommodate with the growth of your baby. Weight gain about 4 pounds is normal to maintain the health of your baby weight support and of yourself. According to the Federal University of Rio Grande do Sul, Porto Alegre, in the second trimester, insufficient weight gain was associated with SGA(small gestational age birth)(45)

2. Darkening skin(46)
As a result of hormone change, occurs in 90 percent of all pregnant women, leading skin darkening. Skin hyperpigmentation is common during pregnancy(47), but there is a rare case report of extensive hyperpigmentation during pregnancy, according to Department of Obstetrics and Gynecology, Bugando Medical Centre(47).

3. Belly stretch marks
It completely normal due to the expansion of your uterus to support the growth of your baby, as the result of your skin is pushed beyond its ability to stretch, resulting in tiny tears. Belly stretch marks affect up to 90% of women, causing emotional and psychological distress(48).  Cocoa butter and olive oil are not effective for preventing SG or reducing the severity of lesions(48).

4. Respiratory tract Congestion(49)(50)
In the second trimester, the respiratory tract lining receives more blood due to certain hormones that stimulate the blood flow in the body, leading to congestion and  causing nosebleeds and sensitive or bleeding gums.

5. Back pain(51)
Although it is very natural that you body started to prepare for the arrive of your body by softening and loosening the joints between your pelvic, most pregnant women experience back pain during pregnancy, a serious issue can negatively impact life quality during pregnancy(52), involvement in ball exercise program can be helpful(52).

6. Pain in the lower abdomen 
As a result of the stretching of ligaments and muscles around to cope with expansion of uterus and it is normal. Acute and sudden onset of  abdomen pain in early pregnancy can be danger of miscarriage due to ovarian torsion(53) and uterine myoma(54).

7. Braxton Hicks Contractions(55)
Braxton Hicks are the “practice run” for your uterus to prepare itself for a healthy delivery(55). It is normally painless which you might feel them in your lower abdomen or groin. According to Dr. Mulder EJ and Dr. Visser GH. Fetal body movements did not stimulate contractions, but coincided to a specific clustering of body movements during the ascending part of contractions(56).

8. Vaginal Discharge
it is a natural reaction of your body as it tries to prevent bacteria invasion that may harm your baby. If the discharge changes color or causes itching or irritation(59), it can be infection. Vaginal candidiasis(57) and lower genital tract infection(58) in pregnancy can induce preterm birth.

9. Breathlessness
As the lung needs to breath harder to provide more oxygen for you and your baby(60). There is a report of half of pregnant women suffer from dyspnea on exertion and some 20 % also from dyspnea at rest(60)

10. Bladder and Kidney Problems
It is very common in the stage, as the expansion of the uterus may interfere with the passage of your urine. Any increased urination, a burning sensation might be a sign of infection.

11. Colostrum Leaking
It is a very common symptoms in the second trimester, as your body is preparing itself to breast feed your baby.

12. Heartburn and constipation
As the result of slower metabolism of your digestive system to allow your blood to absorb nutrients for the baby, causing heartburn and constipation.

13. Legs Cramps
Cramps in the lower leg muscles are fairly common in the second and third trimesters, as result of the expanding uterus put pressure on the veins returning blood from the legs.

14. Libido
In second trimester, some women may experiences an increase sex drive due to increased levels of blood and fluids in the pelvic area due to hormonal change/

15. Even Bigger Breasts
The bigger breast at this stage is very normal as the milk is continued expansion to make sure your breast is ready for feeding your baby when the is born. Some women at this stage, may still experience breast tenderness and it is quite normal.

16. Dizziness
At this stage, more oxygen and nutrients are needed to feed the growth of the baby as your blood vessels dilated to accomplish for this change.

17. Urination
As the growth of uterus continued putting even more pressure onto the bladder, even though it is growing more outward, instead inward in the first trimester, some women still experience urinary frequently, while most of them are feeling more relieve.

What you must aware in the second trimester
1. Cramps and pain in the center of the abdomen
If you are experience severe cramps and pain accompanied with heavy vaginal bleeding,you should go to the emergency room immediately, as it may be a early stage of miscarriage or preterm labor. Any abnormal abdomen pain should be checked your doctor.

2. Infection
a. Vaginal infection during second trimester can happen to some women due to hormonal changes that come with pregnancy. If you are experience some symptoms of vagina infection such as abnormal smelly vaginal discharge, burning during urination, itching around outside part of the vagina, etc., you should check with your doctor as son as possible.
b. Bladder and kidney infections
If you are experience bladder and kidney infection symptoms such as inability to fully empty bladder, blood in urine, sharp pain or burning sensation during urination, chill, fever, etc., please check with your doctor as soon as possible.

3. Abdominal trauma
Presents a risk of severe blood loss and infection, if you are experience any sign of abdominal pain, tenderness, rigidity, and bruising of the external abdomen caused by injury to the abdomen, please contact your doctor immediately.

4. Etc.

Diet for second trimester
The second trimester is the fastest growth stage of the baby. Focusing in providing vary nutritions with a balancing diet is important for you and your baby. The American Pregnancy Association recommends alterations to your diet, including
1. Protein
Protein in your foods positively affects the growth of fetal tissue, including the brain. It also helps your breast and uterine tissue to grow during pregnancy,
a. 75 to 100 grams of protein per day as it can be divided into 2-3 servings of meat (1 serving = approximately 3 ounces/ size of a deck of cards) from chicken lean beef, lamb, pork, nut and tofu (1 serving = approximately ⅓ cup), etc.
b. 2-3 servings of legumes (1 serving = approximately ½ cup) such as red and white kidney beans,black beans, navy beans etc..

2. Calcium
Daily requirement of calcium is around 1000 milligrams during pregnancy. Calcium helps your body regulate fluids, and it helps build your baby’s bones and tooth buds, such as milk (1 serving = 1 cup), eggs (1 serving = 1 large egg), yogurt (1 serving = 1cup),pasteurized cheese (1 serving = approximately 1.5 ounces/ or 4 playing dice stacked together), tofu (1 serving = ½ cup), etc.

3. Iron
In combination with sodium, potassium, and water, iron helps increase your blood volume and prevent anemia. A daily intake of 27 milligrams is ideal during pregnancy.
a. 2-3 servings of green leafy vegetables (1 serving = approximately 1 cup)such as collard turnip, spinach, lettuce, etc.
b. 3 servings of whole grains (1 serving = approximately. ½ cup or one slice), such as bread, cornmeal, cereal, oatmeal, etc.

4. Folate/Folic Acid
Folic acid plays a key role in reducing the risk of neural tube defects, including spina bifida. Experts recommend 600 to 800 micrograms (.6 to .8 milligrams) daily.
a. 2 servings of dark green leafy vegetables (1 serving = approximately 1 cup), such as collard, turnip, spinach, lettuce. etc.
b. 2-3 servings of fruit (1 serving = approximately ½ cup), such as orange, strawberry, lemon, mango, tomato, etc.

5. Vitamin C
Fruits and vegetables rich in Vitamin C will help with wound healing, tooth and bone development, and promotes metabolic processes. Experts recommend at least 85 milligrams per day. 3 servings of fruit or vegetables (1 serving = approximately ½ cup), such as orange, strawberry, lemon, mango, tomato, etc. (Source)

6. Etc.

Herbs to protect your baby and enhance the baby growth in second trimester
Please do not use these herbs until you have consult with your herbal medicine practitioner
1. Chamomile flowers
Chamomile flowers, the dried flower heads of the herb Matricaria recutita is effectively used in herbal medicine to get rid of nauseating feeling, a common symptoms during pregnancy, as well as inducing sleep.

2. Yellow dock
Yellow Dock has been used extensively as herb to cleanse or purify the blood, thus preventing jaundice in newly born baby. Since it contains high amount of vitamin C and iron, it ensures the pregnant women and baby getting enough oxygen for a healthy pregnancy.

3. Ginger root
In a study of Complementary therapies for nausea and vomiting in early pregnancy, researcher concluded that nausea and vomiting are uncomfortable and sometimes debilitating symptoms encountered in early pregnancy. Many of the more conventional remedies offer only partial to negligible relief. Some pregnant women also express scepticism regarding the safety of the more traditionally prescribed pharmacological agents used to combat morning sickness. Vitamin B6, ginger root and acupressure are three complementary modalities that may help alleviate these self-limiting discomforts. Ginger is admired world wide for its anti-inflammatory and anti- bacterial properties. Thus, it works amazingly on morning sickness.

4. Echinacea
Echinacea, a genus of herbaceous flowering plants in the daisy family, Asteraceae has been used traditionally to treat or prevent colds, flu, and other infections by enhancing the immune system. In a study of pregnancy outcome following gestational exposure to echinacea: a prospective controlled study by Gallo M, Sarkar M, Au W, Pietrzak K, Comas B, Smith M, Jaeger TV, Einarson A, Koren G. researchers found that gestational use of echinacea during organogenesis is not associated with an increased risk for major malformations.

5. Red Raspberry leaf
Red Raspberry leaf has been used in herbal medicine as herbal tonic for pregnancy by tonifying the uterus, preventing miscarriage and decreasing constipation due to containing many minerals and vitamins, including vitamin C, calcium and an alkaloid uterus tonifier called fragrine.

6. Nettles
Nettles are species of flowering plants of the genus Urtica in the family Urticaceae contained Vitamins A, C, D and K, calcium, potassium, phosphorous, iron and sulphur of which are necessary for providing nutrients a healthy mother and her baby. The herb has been used in herbal medicine to stop excessive bleeding (vitamin K), prevent hemorrhoids, ease leg cramps and other spasms, nourish and protect the mother and unborn.

7. Etc.

Chinese herbs to protect your baby and enhance the baby growth in second trimester
Dang Gui Shao Yao San is one the recommended formula because it is extensively used in China and Japan and has been monitored in many large-scale clinical trials with pregnant women. The formula was first recommended for use during pregnancy in the Jin Gui Yao Lue, and has been used regularly for the past 1,800 years. In animal studies researchers found that Dang Gui Shao Yao San showed no teratogenic effects (tendency to cause birth defects). The formula has been used to treat female infertility, morning sickness, anemia during pregnancy, and to prevent miscarriage and approved by the Japanese Ministry of Health. The formula used to avoid miscarriage or to treat a variety of pregnancy disorders, but it is also employed as a blood tonic and treatment for mental distress associated with blood deficiency. It includes peony, Chinese angelica root, cnidium, atractylodes, hoelen and alisma.

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References
(40) WHO multicentre study for the development of growth standards from fetal life to childhood: the fetal component.by Merialdi M, Widmer M1, Gülmezoglu AM, Abdel-Aleem H, Bega G, Benachi A, Carroli G, Cecatti JG, Diemert A, Gonzalez R, Hecher K, Jensen LN, Johnsen SL,Kiserud T, Kriplani A, Lumbiganon P, Tabor A, Talegawkar SA, Tshefu A, Wojdyla D, Platt L.(PubMed)
(41) Changes in Your Body During Pregnancy: Second Trimester(Family doctor)
(42) Fetal Development Weeks 14 Through 17(Parents Magazine)
(43) Fetal Development: Second Trimester(American Pregnancy association)
(44) Common physical changes 12 to 28 weeks By Kidspot Team |
(45) Association of second and third trimester weight gain in pregnancy with maternal and fetal outcomes by Drehmer M1, Duncan BB, Kac G, Schmidt MI.(PubMed)
(46) Pregnancy Vlog: 19 Weeks Second Trimester (Melasma, Skin Discoloration or Darkening)Posted in Maternity By Rachel
(47) Extensive hyperpigmentation during pregnancy: a case report. by Massinde A1, Ntubika S, Magoma M.(PubMed)
(48) Stretch marks during pregnancy: a review of topical prevention by Korgavkar K1, Wang F.(PubMed)
(49) Pulmonary Disease and Pregnancy by Tarun Madappa, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP(Medscape)

(50) Pregnancy limits lung function during exercise and depresses metabolic rate in the skink Tiliqua nigrolutea. by Munns SL1, Edwards A2, Nicol S2, Frappell PB2.(PubMed)
(51) Misdiagnosis of sacral stress fracture: an underestimated cause of low back pain in pregnancy? by Deschamps Perdomo A1, Tome-Bermejo F2, Piñera AR2, Alvarez L2.(PubMed)
(52) Effects of a stability ball exercise programme on low back pain and daily life interference during pregnancy by Yan CF1, Hung YC2, Gau ML3, Lin KC4.(PubMed)
(53) Acute abdomen in early pregnancy due to ovarian torsion following successful in vitro fertilization treatment by Tsai HC1, Kuo TN1, Chung MT1, Lin MY1, Kang CY1, Tsai YC2.(PubMed)
(54) [A case of continuous epidural anesthesia for pain relief in a pregnant woman with uterine myoma in the second trimester of pregnancy].[Article in Japanese] by Moridaira T1, Yamamoto G, Hiraishi M, Sakuma K, Taga K.(PubMed)
(55) The uses of Braxton Hicks contractions. by Reynolds SR.(PubMed)
(56) Braxton Hicks' contractions and motor behavior in the near-term human fetus by Mulder EJ, Visser GH.(PubMed)
(57) Treatment of asymptomatic vaginal candidiasis in pregnancy to prevent preterm birth: an open-label pilot randomized controlled trial by Roberts CL1, Rickard K, Kotsiou G, Morris JM.(PubMed)
(58) Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery and Sangkomkamhang US1, Lumbiganon P, Prasertcharoensuk W, Laopaiboon M.(PubMed)
(59) Vaginal Discharge(McKinley Health Center)
(60) Respiratory function in pregnant women by Hirnle L1, Lysenko L, Gerber H, Lesnik P, Baranowska A, Rachwalik M, Leszczyszyn J, Strozecki L(PubMed)
(61) [Evaluation of respiratory tract function in healthy women in the last month of uncomplicated pregnancy].[Article in Polish] by Sroczyński T1.(PubMed)

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