Mid-Pregnancy to early 3rd trimester

What You May Be Feeling

The second trimester marks a turning point for you and your fetus. You will usually begin to feel better and start showing the pregnancy more. Your fetus has now developed all its organs and systems and will now begin growing in length and weight. You will feel the baby’s movements and this will become more regular by 28 weeks. Please read more on expectations of fetal movement.

Grand River Hospital

Even if you are not planning to deliver at Grand River Hospital, Childbirth Pre-Registration Forms are needed for any pregnancy-related hospital services past 20-weeks gestation. Please download, print-off and bring these forms with you to your midwifery team in mid-pregnancy.

Routine Laboratory Investigations and Ultrasounds

Anatomic Ultrasound

The fetus will have developed all its organs and skeletal anatomy by 18-20 weeks and is still small enough to fully visualize these structures using ultrasound. Around 20-weeks gestation is the ideal time for the anatomic ultrasound which will be offered to you.

Laboratory Testing


As your pregnancy continues, the fetus will begin to tax your system more. Between 24-28 weeks, further blood tests will be offered to ensure that your system continues to be healthy. The first test is to repeat a Complete Blood Count (CBC) for your hemoglobin levels. Some pregnancies will have issues with iron-deficiency anemia (low blood iron) and this test will see if further supplement will be recommended.

Gestational Diabetes

The other routine testing offered at this time is to screen for gestational diabetes. Diabetes is a disorder where you are unable to regulate sugar levels in your blood. The hormonal changes associated with pregnancy makes your body less efficient at using sugar. Usually, this will not be a problem, but about 3-6% of Canadian pregnancies will develop gestational diabetes. There are ways to screen for gestational diabetes. The first method is the one-step approach. The one-step approach involves directly doing a diagnostic test called a Glucose Challenge Test (GTT). The one-step approach is available to all clients, but it is the recommended approach if you have risk factors for diabetes.The test involves the following:

Glucose Tolerance Test (GTT)
  • Book an appointment with Life Labs for first thing in the morning
  • Fast for 8 hours
  • At the lab have one blood draw (fasting blood sugar)
  • Have a special orange drink
  • Have a second blood draw one hour after the drink
  • Have a third blood draw two hours after the drink
  • If the results for this test are normal, you do not have gestational diabetes
  • If any one result is abnormal, you have diabetes and will be referred to the Waterloo-Wellington Diabetes Center

The second approach and the second method is the two-step approach call a Glucose Challenge Test (GCT). This test involves the following:

Glucose Challenge Test (GCT)
  • Book an appointment Life Labs for first thing in the morning with
  • Eat a normal breakfast (avoid excessively sweet food or drink)
  • At the lab have a special orange drink
  • Have a blood draw one hour after the drink
  • If this result is normal, you do not have gestational diabetes
  • If this result is not normal, you must do the second step for a diagnosis which is the GTT described above

Rh Immunoglobulin (Rhogam or WinRho)

If in early pregnancy blood work, your blood type is Rh negative then you will be offered Rh immunoglobulin to prevent blood incompatibility issues between you and your baby. Rh Immunoglobulin is administered at Grand River Hospital at 28-weeks gestation.

Recommended Immunization in Pregnancy

There are currently three recommended vaccinations in pregnancy. Both the seasonal influenza (flu) and the covid-19 vaccines are recommended in pregnancy as fall boosters. These are available through a family doctor or at a local pharmacy. The Pertussis (Tdap) vaccine is also recommended to all pregnant people ideally between 27 and 32 weeks gestation. The Tdap vaccine can be administered to you at a routine prenatal appointment by your midwifery team.