Trimester-wise History Taking in Antenatal Care: SECOND Trimester

The main focus in this period is fetal well-being and growth, screening for early complications, and ensuring vaccination is up-to-date.
1. Ask about Antenatal Visits: How many ANC visits in this trimester?
• Helps assess if antenatal care has been adequate and timely

2. Vaccination– Td (Tetanus & Diphtheria): If received any tetanus injections during this trimester? Ask about Td vaccine timing
If vaccination status is unknown, there may be a need to give 2 doses 4 weeks apart.
If completely vaccinated in last 3 years, only 1 booster is needed.

3. Quickening: (Fetal Movement Felt by the Mother for the FIRST time in current pregnancy)
Ask when did the mother first perceive fetal movements:
Typically, a Primigravida feels at 18–20 weeks and a Multigravida at 16–18 weeks
Clinical importance:
• Confirms a live fetus at that time.
• Helps estimate gestational age, especially if LMP is uncertain or cycles were irregular.
• Estimating EDD using quickening:
o Primigravida: Date of quickening + 20 weeks
o Multigravida: Date of quickening + 22 weeks
Note: These methods are approximate and used only when LMP/early scan is unreliable.

4. Iron and Calcium Supplementation: Ask about compliance with supplements
1. Iron–Folic Acid (IFA): under ‘Anemia Mukt Bharat’:
• Prophylactic: One tablet (60 mg elemental iron + 500 mcg folic acid) daily from 2nd trimester for at least 180 days and to continue for 180 days after delivery.
• Therapeutic IFA (if anemia is diagnosed): One tablet TWICE daily for the same period
2. Calcium: One tablet (500 mg calcium +250 IU Vitamin D3), Twice a day, From second trimester (14 weeks) onwards throughout pregnancy for 6 months (360 tablets) and continued for 6 months after delivery (360 tablets) taken in between meals
• Iron folic acid tablet and calcium tablets should not be taken together at the same time.
• There should be a gap of at least 2 hours between IFA and calcium for better absorption of both.
• Calcium should not be taken immediately after a meal.

5. Ask for Symptoms Suggestive of Preeclampsia
• Headache
• Blurred vision
• Epigastric pain
• Decreased urine output
• Sudden or excessive weight gain
• Swelling of face/hands/feet
Physiological edema of feet may occur in late second trimester; still the possibility of pre-eclampsia must be ruled out
• If edema feet disappears after rest, it is likely to be physiological;
• Nevertheless, you must question about headache, visual disturbance and oliguria, to rule out pre-eclampsia
Normal weight gain: 10–12 kg during pregnancy; about 5 kg in the 2nd trimester.

7. Screening for Gestational Diabetes Mellitus (GDM): Ask whether GDM screening has been done.
Universal screening is done at the first visit and a repeat screening at 24–28 weeks.

8. Ask if the Second Trimester Anomaly Scan has been done at 18–22 weeks for detecting major structural anomalies

9. Ask about Maternal Comfort and Sleep
Though there is individual variation, the usual advice is: 10 hours rest (8 hours at night + 2 hours during the day).
• In late pregnancy, left lateral position—improves comfort and uteroplacental blood flow.

10. Any Bleeding per vaginum

References:
• Dutta DC. Textbook of Obstetrics. 9th ed. Jaypee Brothers; 2023.
• Padubidri VG, Daftary SN. Shaw’s Textbook of Gynaecology. 18th ed. Elsevier; 2022.
• Park K. Park’s Textbook of Preventive and Social Medicine. 28th ed. Bhanot; 2025.
• Babu SA. Clinical Obstetrics and Gynecology. 2nd ed. Wolters Kluwer; 2025.
• Care During Pregnancy and Childbirth: Training Manual for Community Health Officers. Ministry of Health and Family Welfare, Government of India; 2019. Available from: https://nhsrcindia.org/sites/default/files/2021-12/Care%20During%20Pregn... (Accessed 2025 Nov 17).
5-Page ANC History Taking Format: https://ihatepsm.com/blog/5-page-anc-history-taking-format-essential-gui...
Why ANC History Taking Matters?: https://ihatepsm.com/blog/why-anc-history-taking-matters

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Trimester-wise History Taking in Antenatal Care: SECOND Trimester