Complication in 2nd Trimester
most women, the 2nd trimester is relatively
problem free period. The hormonal changes are
setting and you still may fit into your pre pregnancy
clothes. This period usually involves antenatal
visits, routine tests,
and maintaining healthy lifestyles. But,
some complications do occur. It is important to
recognize them early and treat them effectively
so that it will benefit you and your baby. Some
of these problems are
Os - Miscarriage incompetence.
miscarriage is less common in the 2nd
trimester than in the 1st, a risk still
exists. Any kind of bleeding should be reported
to the obstetrician immediately.If bleeding is
spotty, there is no cause for concern as it may
be due to local vaginal or cervical infections.
Moderate to severe bleeding is a cause of concern
probably as it can be a sign of impending abortion.
known, as ‘painless abortion’ is a well-recognised
cause of pregnancy loss in late 2nd
trimester. The mouth of the uterus (cervix) begins
to open (dilate) and thin out (effacement) before
a pregnancy has reached full and nine months (full
term). This occurs in the absence of pain and
uterine contractions and without much pain or
often does this occur?
It is relatively uncommon, occurring in 1 - 2 % of all pregnancies.
However as it leads to repeated miscarriages,
it is important to identify and treat it.
The premature opening of the mouth of uterus with
its thinning is primarily due to weakness in the
cervical musculature. The sphincter, which is
closed normally, is not able to withstand the
pressure of growing pregnancy.
incompetent cervix could be a result of cervical
to overzealous mechanical dilatation of the
cervical laceration during delivery.
conisation of cervix for the treatment of cervical
dysplasia (early cervical carcinoma).
women who are at the risk are women with polyhydramnios
(excessive amount of amniotic fluid, more than
2 – 5 liters), multiple pregnancy (causing excessive
stretching of uterine musculature).
defects of the genital tract.
What do you feel?
process is relatively painful and onset may be
mucus discharge through the vagina followed
by spotting and bleeding.
sensation of pressure or heaviness in the lower
abdomen, surprisingly no pain.
to arrive at a diagnosis?
typical history of repeated midtrimester miscarriage
is often enough to diagnose the condition. In
pregnancy, some tests may be useful for confirmation,
It will show opening of the mouth of uterus
(internal os) with funneling and bulging of
the foetal membranes (sac) into the cervix.
swab for culture of bacteria to rule out infection
and treat it if present.
and blood examination for general condition.
of vaginal or cervical infection.
cerclage operation: This is a small procedure
by which a stitch is taken at the mouth of uterus
for mechanical closure. This stitch must be
removed at 37 completed weeks of pregnancy or
at the time of initiation of labour, whichever
is earlier. The ideal time to do the operation
is around 18 – 20 weeks of pregnancy. However,
the placement of circlage stitch doesn’t completely
protect women from ‘incompetent os’ or preterm
treatment such as bed rest and tocolytic agent
(medication which prevents uterine contraction)
may also be needed.
labour involves progressive pain and uterine
contractions causing opening of the mouth
of uterus (cervix) before 37 weeks of pregnancy.
Babies who are born this early often have
low birth weight, prematurity and various
other problems, which put them into numerous
health risks. Now, the majority of babies
born after 28 – 30 weeks do survive. However,
10% of them suffer from permanent major
handicap. The financial and emotional costs
of newborn intensive care is staggering.
Higher still are the costs of long-term
care for the handicapped children.In order
to avoid this, women must understand the
warning signals and report to the obstetrician
often does this happen?
does preterm labour occur?
exact cause is unknown yet. But, the factors
that seem to increase a woman’s risk of
early labour have been identified. These
factors include the following:
with twins, triplets or more. .
2nd trimester abortion.
(excessive amniotic fluid around baby more
than 2.5 liters).
of the amniotic fluid or the foetal membranes.
of the mother’s uterus.
illness or disease in the mother.
heavy working conditions, poor socioeconomic
do you feel?
is advisable to know at this juncture who
is at risk of developing preterm labour.
A Woman who has poor past reproductive performance
is at risk of developing the same.’The warning
signals are given below. If you find any
of these, do not hesitate to call upon your
doctor. Even if, it turns out to be a false
call your doctor wouldn’t mind it as prevention
of preterm labour is far better than attempting
symptoms of preterm labour :
lower abdominal pain like period pains
either constant or comes and goes, This
is usually lower down below the umbilicus
in the centre.
dull, backache (constant or comes and goes).
(feels like the baby is pushing down, feels
cramping (with or without diarrhoea).
or change in vaginal discharge (may be mucous,
watery, light or bloody.
leaking from the vagina.
contractions that are 10 minutes apart or
closer (may be painless). Women are 75% accurate
in their ability to recognise warning symptoms
of preterm labour.
to arrive at a diagnosis?
It is very important for you to inform
your obstetrician if you fall in the risk
group. This cooperative effort helps to
manage your pregnancy better to make sure
it reaches till full nine months.
plan is like:
for infections – like urinary
or vaginal – and its treatment.
the warning signals.
the working conditions from heavy to moderate
at regular intervals to know the status of
the mouth of the uterus (cervix).
antenatal visits and check up.
you have any symptoms or signs to preterm
labour, you may require one or more of the
following specific treatment.
– may or may not be required– depends on your
– to treat infection.
which prevents or reduce the onset of
therapy – this depends upon the stage
of pregnancy and labour for facilitating
long growth of the foetus.
the delivery is inevitable, it is advisable
see that you deliver at a centre with to have
a good neonatal unit as a back up, so that
your baby receives best care immediately.