Second Trimester -
Subjective symptoms -
The subjective symptoms such as nausea, vomiting and frequency of
micturition usually subside while amenorrhoea continue. The new features
that appears are -
1. Quickening (feeling of life) - Denotes the perception of action fetal movement
by the women. It is usually felt about the 18th week,
above 2 weeks early in multipara.
2. Progressive enlargement - Progressive enlargement of the lower abdomen by the
growing uterus.
General examination / Objective symptoms -
1. Chloasma - pigmentation over the forehead and chick may appaer at about 24th week.
2. Breast changes - breast are more enlarged with prominent vein under the skin.
Abdominal examination -
1. Inspection -
a) Liner pigmented zone ( Linea nigra may be visible at 20th week ).
b) Straie ( both pink and white ) of varying degree are visible in the
lower abdomen, more towards the flanks.
2. Palpation -
- The uterus feels soft and elastic.
- Braxton Hick's contraction are evident.
- Palpation of fetal part can be made distinctly by 20th week.
- Active fetal movement can be felt at intervals by placing hand over
the uterus as early as 20th week, it not only gives positive evidence
of pregnancy but of a live fetus.
- External ballotement
3. Auscultation -
a) Fetal heart sound is the most conclusive clinical sign of the pregnancy
with an ordinary stethoscope, it can be detected 18 to 20 week.
b) Uterine souffle and funic or fetal souffle (for details, see further posts)
Vaginal examination -
- The bluish discoloration of the vulva, vagina and cervix is more evident
so also softening of the cervix.
- Internal ballottement can be elicited between 16th to 28th week.
Investigation -
1. Sonography - Routine sonography at 18 to 20 weeks permits a survey
about fetal anatomy and placental location.
2. Radiography - Radiologic evidence of fetal skeletal shadow may be visible
as early as 16th week.
Subjective symptoms -
The subjective symptoms such as nausea, vomiting and frequency of
micturition usually subside while amenorrhoea continue. The new features
that appears are -
1. Quickening (feeling of life) - Denotes the perception of action fetal movement
by the women. It is usually felt about the 18th week,
above 2 weeks early in multipara.
2. Progressive enlargement - Progressive enlargement of the lower abdomen by the
growing uterus.
General examination / Objective symptoms -
1. Chloasma - pigmentation over the forehead and chick may appaer at about 24th week.
2. Breast changes - breast are more enlarged with prominent vein under the skin.
Abdominal examination -
1. Inspection -
a) Liner pigmented zone ( Linea nigra may be visible at 20th week ).
b) Straie ( both pink and white ) of varying degree are visible in the
lower abdomen, more towards the flanks.
2. Palpation -
- The uterus feels soft and elastic.
- Braxton Hick's contraction are evident.
- Palpation of fetal part can be made distinctly by 20th week.
- Active fetal movement can be felt at intervals by placing hand over
the uterus as early as 20th week, it not only gives positive evidence
of pregnancy but of a live fetus.
- External ballotement
3. Auscultation -
a) Fetal heart sound is the most conclusive clinical sign of the pregnancy
with an ordinary stethoscope, it can be detected 18 to 20 week.
b) Uterine souffle and funic or fetal souffle (for details, see further posts)
Vaginal examination -
- The bluish discoloration of the vulva, vagina and cervix is more evident
so also softening of the cervix.
- Internal ballottement can be elicited between 16th to 28th week.
Investigation -
1. Sonography - Routine sonography at 18 to 20 weeks permits a survey
about fetal anatomy and placental location.
2. Radiography - Radiologic evidence of fetal skeletal shadow may be visible
as early as 16th week.
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