second trimester emergency, when to call for help

You made it! The second trimester is usually the best.  For most women, the nausea eventually subsides, your energy level returns (a little at least), and you are not yet so big as to inhibit most of your normal day to day activities.

In addition, that first trimester miscarriage anxiety is decreasing a little because you know your risk of pregnancy loss is now 1% or less.

For most of you, visits with Kamm Mckenzie are usually only monthly. Excitement builds as you look forward to your anatomy sonogram.  At some point you will start to feel the baby move.

Then, most of you get to close out your 2nd trimester and begin your third with the wonderful, sweet, mouth puckering, orange or lemon lime flavored gestational diabetes beverage...yummy!

If you read my last blog, I dove into what warrants an emergency call during the first trimester, and what can wait until the office is open again. I am going to try to address some of the more common second trimester emergencies and comment on things that are not emergencies within that discussion.

As always, use your superpower maternal instincts and call if you think you need to.

Bleeding: If you are hemorrhaging you need to call.

So what exactly is this? I would say if you are saturating a pad an hour we should 100% hear from you.

If you have a touch of brown on your underwear or liner, or a touch a pink when you wipe that can probably wait until the next time the office is open. If the bleeding is light (even if red) but was preceded by sex, then that will usually stop and is not an emergency until it gets to the point of hemorrhage.

Because we cross the threshold of a viable pregnancy during the second trimester (this is a VERY fluid point but is currently in the 23-24 week range), we do have a lower threshold for a call if you are bleeding bright red blood.  We will definitely want to hear from you if you are 23+ weeks and having bright red bleeding.

Pain: If you are having intense pain, you should call us.

This is especially true if you the pain is rhythmic, like labor contractions. Usually labor is pretty obvious, but not always.

A common pain that happens around 18-20 weeks (and continues throughout) is a shooting pain in the lower sides of the belly that shoots down into the groin.  It is usually associated with activity or position changes. We call this “round ligament pain” due to the fact that this pain is from the ligaments that support the uterus, called the round ligaments.

When you get to 18-20wk the uterus moves outside of the pelvis and can move around more, thus pulling on these ligaments and causing some significant discomfort.  Round ligament pain is not an emergency. 

Discharge: If you are having a marked change in discharge, you should call.

Pregnancy is infamous for a wonderful baseline discharge.  It is usually white and thin and gets more and more copious throughout.

If your discharge changes significantly… especially if it gets more mucousy and blood tinged, we want you to call us.  If you are simply having what you think is yeast or BV (bacterial vaginosis) that can wait until the office opens. 

Fetal movement: If there is a marked decrease in fetal movement, call.

This one is tricky because many women do not start feeling the baby move until as late as 24 weeks. Even after that, the amount of movement a women senses is so variable for weeks.

In addition, we do not even recommend doing fetal kick counts or anything like that until well into the third trimester, as babies are hard to feel all the time during the second trimester.

That being said, if you HAD been feeling your baby move ALL the time and are having a significant amount of time without feeling it, and are more than 23-24 weeks pregnant, please call us.

As I discussed in the first trimester emergencies blog post (and won’t bore you with further elaboration here), things like GI bugs, mild fevers, upper respiratory infections, medication questions, and basic pregnancy questions certainly can wait for office hours or can be found on our website.

I hope this helps answer some of the “what ifs” regarding second trimester emergencies.  Keep your eye out for third trimester emergency calls and labor precautions blogs upcoming.

Dr. B