Once your pregnancy has progressed to the fourth month, the risk of complications decreases considerably; miscarriages at this stage, known as late miscarriage, account for less than 25 percent of all miscarriages. Meanwhile, ectopic pregnancy occurs usually in the first trimester, but it can go to term. This is known as an "abdominal pregnancy." It is at this stage that you'll begin to look pregnant, rather than just be mistaken for "chubby." Most women will begin to feel a little less nauseated at this point, too, but morning sickness occasionally persists well into the second trimester or even throughout the third trimester. You'll also be watched for signs of hypertension or diabetes, common in women who come from high-risk families. Begin having "official" prenatal exams, which will include regular testing of your blood sugar levels because of the frequency of gestational diabetes developing at this stage. Also, begin to go for various prenatal tests depending on your age and risk group.

When there is an end to morning sickness, you'll begin to feel better in some ways but decidedly more "pregnant" in others. By now, your waist will have expanded considerably and you won't be able to fit into many of your prepregnancy clothes. You'll begin to feel fetal movement, sometimes called quickening, in the early part of the second trimester. This date is important to note because it will help your doctor date the pregnancy more accurately.

At this point, your entire circulatory system is changing. Your total blood volume increases, your bone marrow produces more blood corpuscles, and your heart will be changing position and increasing slightly in size. You may notice that you're salivating more frequently, which is sometimes associated with nausea or is more pronounced if you're nauseous. You may sweat more as well. At this stage, the weight of your uterus increases twenty times, while the bulk of your weight gain will take place after the twentieth week. As your abdominal area stretches, you may notice stretch marks, lines with pinkish or reddish streaks that appear across your stomach. Your skin may also be drier. There are other symptoms that might creep up, such as iron-deficiency anemia and a host of other problems that vary from woman to woman.

By midpoint in your pregnancy, your breasts will have become fully functional, ready for breast-feeding. Around the nineteenth to twentieth week, your nipples will secrete a yellowish liquid known as colostrum, a crucial premilk substance that nourishes the baby until your mature breast milk comes in.

Constipation gets worse as the pregnancy progresses. A good high-fiber diet (discussed with your doctor and/or nutritionist) will help this. Even so, hemorrhoids may become unavoidable at this point because of pressure on your pelvic organs and the dilation of veins in your rectum. Another tip is to prop your feet up on a stool when you move your bowels. For remedies, Preparation H, petroleum jelly, or vitamin E oil work fine.

Women can experience heartburn all through the pregnancy. It is most common in the last trimester, but it can also start at some point in the second trimester and continue until the end. Heartburn is a burning sensation in the middle of your chest or upper digestive tract. It's caused by progesterone, which relaxes the muscle that controls the opening at the top of the stomach. Progesterone also causes the stomach, which is pressed upward by the growing fetus, to empty more slowly. The bottom line is that the stomach doesn't work as well as it should. Here are some tips that might help:

1. Avoid fatty and greasy foods, carbonated drinks, processed meats, and junk foods. Ask your nutritionist to recommend a heartburn-friendly diet.

2. Eat slowly and chew your food well before you swallow. This will give the enzymes in your saliva a chance to work better and help to break down the food, which will relieve some of the digestive "workload" from your stomach.

3. Try not to eat later in the evening (after 8 P.M.) when you're less active.

4. Try not to drink with your meals. If you don't wash down the solids with liquid, you're likely to eat slower and swallow less air.

5. Avoid coffee, tea, smoking, and antacids that contain bicarbonate.

Because your blood volume has increased by about 40 percent and your hormonal levels have increased, you might notice an occasional nosebleed. This is nothing to worry about. Keep a little petroleum jelly in each nostril, which will help prevent dryness, which can, in turn, trigger a nosebleed.

A thin, milky, painless, inoffensive-smelling vaginal discharge will develop around now and get heavier as the pregnancy progresses. This is known as leukorrhea, caused by an increase in hormonal activity. You may need to wear light-day pads for this. You should also review vaginal hygiene rules. Yeast infections may persist throughout your pregnancy, however.

Edema means "water retention" and can cause swollen ankles, swollen fingers (to the point where you might need to take off your rings), and general all-around puffiness. Depending upon the severity of the edema, a number of other problems can develop. Carpal tunnel syndrome is one of them. This is when the increased fluid in your wrists cuts off the nerve in the wrist responsible for feeling in the fingers and hands. Women who develop this may feel tingling or burning sensations in their fingers. This usually corrects itself in time or can be corrected with a splint. If the problem persists after delivery, minor surgery can correct the problem. Other edema-related problems also tend to correct themselves in time as the fluid levels in the body drop. When you are pregnant, the increase in estrogen causes you to retain more fluid, essential for nourishing the placenta and maintaining adequate milk flow.

Your veins may change drastically, but this is a normal part of pregnancy. Venous changes range from unsettling blue lines under the skin around the breasts or abdomen to bona fide varicose veins. These blue lines are just more prominent and expanded veins. They've expanded because your blood supply has increased, which is necessary to nourish the fetus.

Some women get spidery, purplish lines up and down their thighs, known as "superficial varicosities." "Spider nevi," or telangiectases may develop too, which are similar lines on the chest. Both result from hormonal changes. These lines might fade or disappear after pregnancy. If they don't, they can be remedied through minor cosmetic procedures.

As for varicose veins, these tend to run in families. The veins carry blood back from all your extremities and your heart. The veins are designed with valves to prevent the blood from flowing backward in the veins. The valves need to work against gravity when they're carrying blood up the leg. Sometimes the vein valves are faulty or missing, which causes the blood to collect in areas where the gravity is most pronounced: the legs, rectum, or even vulva. These blood "pools" in the legs are noticeable, clumpy, and painful. Unfortunately, an expanded blood volume and an increase in progesterone just makes the condition more pronounced or will initially trigger it in women who haven't yet suffered from varicose veins but who are vulnerable to them.

Sometimes the only sign of varicose veins is the appearance of faint bluish lines in the areas where the blood pools. A bulging can crop up anywhere from the ankles to the vulva. In more severe cases, thrombophlebitis can develop, which means "inflammation of the vein due to blood clot." When a clot develops in a vein, this is known as venous thrombosis.

Clotting usually occurs in the postpartum period, but varicose veins can develop at any point in the pregnancy. The treatment revolves around prevention: maintaining a healthy pregnancy weight (overdoing it can worsen varicose veins); raising your legs while lying down (stick a pillow under them to get the blood flow moving); wearing support pantyhose (this keeps the blood circulating); avoiding restrictive clothing, such as tight belts, snug shoes, garters, girdles, and so on; and daily walks (about twenty to thirty minutes a day).

When something goes wrong during the second trimester of your pregnancy, it usually has to do with your health (gynecological or otherwise), premature labor, or a problem with the placenta. Space does not allow me to list everything that can go wrong, but the following are among the most common problems affecting average and high-risk pregnancies.

In the second trimester, light or spotty bleeding is often caused by either an increasingly sensitive cervix, which may be irritated during an internal exam, or by sexual intercourse. Notify your doctor immediately.

Between the third month and twentieth week of pregnancy, a spontaneous abortion is known as a late miscarriage. The symptoms are similar to the first trimester miscarriage variations. In many cases, a condition known as an "incompetent cervix" is responsible. This is when the cervix dilates prematurely and can't hold in the fetus. If an incompetent cervix is caught early enough, the cervix can be stitched up and the pregnancy can be resumed. Then, at labor, the stitches can be removed and a normal vaginal birth can take place. Some stitching techniques are permanent, however, and a cesarean section is required.

If the miscarriage is inevitable and can't be prevented, a D & C can be performed up until the twentieth week. A miscarriage after twenty weeks is no longer a miscarriage. It graduates to either a premature birth or, in unfortunate cases, a stillbirth. You'll also need to follow emergency instructions outlined above.

Premature labor is characterized by contractions accompanied by bloody discharge, anywhere from the twentieth week to the thirty-seventh week. Other symptoms of premature labor are menstrual-like cramps, with possible diarrhea, nausea or indigestion, lower back pain, and all the other symptoms of labor discussed below. This is an emergency situation and can be treated with medications that postpone the labor. In the worst-case scenario, the baby is delivered prematurely and treated in a neonatal intensive care unit.