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Congratulations on getting to the 21st week of pregnancy! You’ve crossed the halfway mark of your pregnancy, can feel your baby kick and move in the womb, and are probably also garnering a lot of compliments about your pregnancy and the accompanying glow now. 

The 21st week of pregnancy can actually feel like a very comfortable time. However, your abdomen is growing and you may feel a little off-balance at times. Your baby is growing rapidly, and you’ll find him or her responding to you talking, singing, etc., by kicking and moving about.

Of course, the second trimester comes with its own set of complications too, and you should take all of these very seriously. Your uterus hasn’t just grown bigger to accommodate a growing baby, but it has also changed its form completely. This makes you more susceptible to bacterial infections, urinary tract infections, and other types of infections as well.

There’s also a risk of hypertensive diseases, preterm premature rupture of membranes (PPRoM), premature labour and stillbirth. Not all of these complications can be controlled or avoided once they do start, so it’s best to take precautions against these complications of pregnancy by following a proper pregnancy diet, exercise routine and your doctor’s recommendations about sleep, rest, medications, etc.

  1. Baby size and features at 21 weeks of pregnancy
  2. Changes in your body by the 21st week of pregnancy
  3. 21 weeks of pregnancy symptoms
  4. Complications in the 21st week of pregnancy
  5. Things you should do in the 21st week of pregnancy
  6. Takeaways for the 21st week of pregnancy

Your baby is now about 26.7cm long from head to toe, and that’s as big as a carrot. He or she also weighs approximately 350g, and this weight is likely to be more than that of the placenta right now. The placenta, which manages both your baby’s nutritional intake and waste disposal, will continue to grow throughout the pregnancy, but now your baby will grow faster and remain bigger than the placenta all the way to the date of delivery.

Not only is your baby actively ingesting the amniotic fluid but is also urinating it out actively now. His or her digestive tract is developing quickly now, and the intestines have developed enough to absorb sugar. Until now, your baby’s liver and spleen were making the red blood cells - but now, the bone marrow is developed enough to start helping out. The bone marrow will play an even more important role as the third trimester approaches, and well after the baby’s birth as well.

Your weight has increased, your abdomen is progressively protruding outwards, your joints feel looser and your centre of gravity has changed. If this doesn’t make you feel a little wobbly and unbalanced, then what will? If you’ve also got high blood pressure or low blood pressure right now, you might experience a few falls.

Falling down a little or bumping objects might seem very alarming, but don’t immediately panic. Your baby is cushioned by the amniotic sac and fluid. That said, you should obviously take every possible precaution to guard against falling. Get your blood pressure checked by the obstetrician, and consult him or her if you do fall down or feel dizzy.

Your baby is likely to be very active in the womb right now, and you, in turn, are likely to feel every movement as the pregnancy progresses. You might also realise that your own schedule does not match that of your baby, and he or she kicks hardest when you’re trying to get some rest. Getting proper sleep might be your biggest agenda if this is indeed happening.

While it’s true that you won’t experience any morning sickness at this stage of your pregnancy, quite a few symptoms of pregnancy will show up in the second and third trimesters.

Managing these symptoms will need proper prenatal care, including a healthy diet, exercise and adequate medical attention when required. You must drink enough water throughout the day, and get enough rest and sleep as well to manage these symptoms better. The following are some of the key symptoms of pregnancy you’re likely to experience in the 21st week of pregnancy.

  • Round ligament pain: Round ligament pain is a type of pain that pregnant women experience in the lower belly or groin area, either on one side of these areas or across them. This is one of the most common complaints in the second trimester, so it’s quite normal. However, if you cannot bear the pain or it appears to be too much, do consult the doctor immediately.
  • Sleep problems: Whether it’s because of all the aches and pains, the leg cramps, indigestion during pregnancy, trips to the bathroom, heartburn or any other symptoms of pregnancy, getting a good night’s sleep might seem like an elusive goal during pregnancy. Not getting enough sleep can lead to stress and other serious issues, so make sure you consult your doctor about it.
  • Fatigue: Your body is pumping more blood, your weight has increased, there’s a life growing inside you and you still have to remain active and make sure your daily functions are performed. Fatigue is quite natural under these circumstances, so don’t beat yourself up about it. Instead, make sure you get enough rest, get undisturbed sleep and eat well.
  • Sciatic nerve pain: If you are experiencing a lot of pain in your legs, it could be because your sciatic nerve is getting pressed. This can happen due to your added weight and the pressure of the womb on the sciatic nerve, which passes below the womb. Sciatic nerve pain is quite normal during pregnancy, especially during the second and third trimesters. The best thing to do about it is to rest as much as possible.
  • Melasma: Melasma, also known as chloasma or the mask of pregnancy, basically refers to the dark patches of skin that might appear on your forehead, cheeks, and other parts of the face during pregnancy. This usually occurs due to hormonal changes during pregnancy, and these dark and symmetrical patches are likely to disappear a month or two after delivery as your hormone levels go back to normal.
  • Varicose veins: A lot of women may start noticing varicose veins in their legs, genitals and rectum, which can be a cause of concern and discomfort. This usually happens during pregnancy because the growing uterus puts pressure on the large vein, known as inferior vena cava, that carries blood back from your legs and feet to the heart. Varicose veins in the rectum are basically the cause behind haemorrhoids or piles, which might be another symptom of pregnancy during this week.
  • Other symptoms: While the above are some symptoms that might show up in the second trimester, some symptoms from the first trimester are likely to persist and even get worse. This includes bleeding gums, swollen gums, heartburn, indigestion, bloating, constipation, breast pain in pregnancy as your body prepares for breastfeeding, headaches, nosebleed and mood swings.

There are a number of complications which might show up during the 21st week of pregnancy, and not all of them will be under your control. Some complications, like infections, might be easily managed if diagnosed in time. However, premature labour and stillbirth and issues you cannot stop once they start. The following are some of the complications you should be aware of and cautious about in the second trimester of pregnancy. 

  • Hypertensive diseases: Hypertensive diseases are a group of health issues related to high blood pressure which are likely to show up in the second trimester. These issues include preeclampsia, eclampsia, gestational hypertension and chronic hypertension. Most of these disorders can have serious implications for both the mother and child, so consulting with your doctor about these, going in for regular checkups, and getting the treatment recommended by the doctor are very important.
  • Infections: Unless you’re living in a bubble, you might not be able to completely avoid vaginal infections, viral infections, bacterial infections, fungal infections and urinary tract infections. It is also important to get tested for sexually transmitted infections (STIs) while you’re pregnant, as these infections can affect your health as well as the well-being of your baby. Taking care of your hygiene is of the utmost importance during your pregnancy. Additionally, you should also take precautions against disease outbreaks, especially the highly contagious ones like COVID-19. (Read more: What pregnant women need to know about COVID-19)
  • Subchorionic hemorrhage: Bleeding during pregnancy can be a cause of worry because there isn’t supposed to be any vaginal bleeding during pregnancy especially during the second trimester. However, if the placenta detaches from the area where it was implanted for any reason, it can cause a subchorionic hemorrhage or hematoma due to placental abruption. Depending on the size of the hemorrhage, the bleeding can be light or heavy. It’s best to consult your obstetrician if this problem shows up at all.
  • Obstetric cholestasis: Obstetric cholestasis is a type of liver disease that may show up during the second or third trimesters of pregnancy. Though rare, Indian women are more at risk of suffering from obstetric cholestasis, and it can have some severe repercussions for your baby as well, including premature labour, low birthweight, etc. The main symptom is itching on the hands and feet, especially during the night, so if you observe this symptom, get yourself checked immediately.
  • Stillbirth: While the loss of a foetus before the 20th week of pregnancy is known as a miscarriage, a sudden loss after the 20th week is known as stillbirth. If the stillbirth occurs between the 20th and 27th weeks of pregnancy, it’s known as an early stillbirth. There are a number of risk factors associated with stillbirth even though its precise causes are not known yet. Developments in medicine and medical technologies have made it possible to reduce the risk of stillbirth if caught in time. Hence, if you do see any symptoms like contractions, vaginal bleeding, etc., contact emergency health services immediately.

You might receive the results of the anomaly scan or level 2 ultrasound done between the 18th week of pregnancy and the 20th week of pregnancy during this week. Follow your doctor’s recommendations, no matter what the results show, because your obstetrician wants the best outcome for both you and your foetus. The following are some other things you must remember to get done this week.

  • While a minor fall or bump here or there should not harm your baby, it’s best to avoid risks of such accidents while travelling. This might be the time to invest in a “baby on board” sticker for your vehicle or a badge if you take public transport.
  • Stay well away from any foods that are deemed risky during pregnancy. This includes raw foods like fish, seafood and eggs, as well as soft cheeses. These can increase the risks of infections like salmonella and listeriosis. (Read more: Is it safe to eat fish during pregnancy?)
  • If you suspect you have an infection, depression or any symptoms of any complications, call the doctor and ask if you can come in for a check-up. This is important because delaying treatment can make the symptoms of most diseases worse, and timely treatment can protect your health as well as that of your baby.
  • Follow a healthy diet and maintain a good exercise routine this week. These will help you stay fit and active and also ensure that your baby gets all the nutrition he or she needs.
  • Maintain contact with your obstetrician and follow the general rules and recommendations given by them. If you see any sign of an infection or any other complication, call your doctor immediately instead of delaying unnecessarily.

The 21st week of pregnancy is a good place to be in, because this is the time when the symptoms aren’t too severe and the increasing discomfort you’re bound to experience as your pregnancy enters the third trimester is not yet approaching. While this is the golden period of your pregnancy, you might want to take ample precautions against all the complications mentioned above.

An added cause of concern is depression in pregnancy, which many women suffer from. If left untreated, this can progress to postpartum depression - so, the best thing to do is take the signs into account. The spouse, family and friends of a pregnant woman also have a role to play in taking care of her mental health.

Overall, you will find that communicating with your partner, taking time off to reduce stress and anxiety and taking ample prenatal care is all you need to keep both mental and physical health problems at bay as your pregnancy progresses.

References

  1. Start4Life. National Health Service [Internet]. Hertfordshire. UK; Week 21 – your second trimester
  2. American Pregnancy Association [Internet]. Irving, Texas, USA; Pregnancy Week 21
  3. Nemours Children’s Health System [Internet]. Jacksonville (FL): The Nemours Foundation; c2017. Week 21
  4. National Health Service [Internet]. Hertfordshire. UK; You and your baby at 21 weeks pregnant
  5. Hawkins, Lesley. et al. Spontaneous uterine rupture and surgical repair at 21 weeks gestation with progression to live birth: a case report. BMC Pregnancy Childbirth. 2018; 18: 132. PMID: 29728141
  6. Butcher, CJ. et al. Chest pain, breathlessness and ST elevation in a 21-weeks' pregnant woman: a diagnostic and management challenge. BMJ Case Rep. 2010; 2010: bcr0320102853. PMID: 22802274
  7. Allanson, Ben. et al. Infection and Fetal Loss in the Mid-Second Trimester of Pregnancy. Aust N Z J Obstet Gynaecol . 2010 Jun;50(3):221-5. PMID: 20618237
  8. Roiz-Hernandez, J. et al. Human Chorionic Gonadotropin Levels Between 16 and 21 Weeks of Pregnancy and Prediction of Pre-Eclampsia. Int J Gynaecol Obstet . 2006 Feb;92(2):101-5. PMID: 16325185
  9. Nemours Children’s Health System [Internet]. Jacksonville (FL): The Nemours Foundation; c2017. Why Do Some Pregnant Women Get Varicose Veins?
  10. Greenstone, SM. et al. MANAGEMENT OF VARICOSE VEINS DURING PREGNANCY. Calif Med. 1957 Dec; 87(6): 365–367. PMID: 13489493
  11. Centers for Disease Control and Prevention [Internet], Atlanta (GA): US Department of Health and Human Services; What is Stillbirth?
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