The Second Trimester

Paul Rothman appointed to second term as leader of Johns Hopkins Medicine

The Second Trimester | Johns Hopkins Medicine

With enthusiastic support from university and Johns Hopkins Medicine leaders and colleagues, Paul Rothman has been appointed to a second term as CEO of Johns Hopkins Medicine and dean of Johns Hopkins University's School of Medicine. He began a new six-year term this summer.

In a message today to faculty, staff, and students, Johns Hopkins University President Ronald J. Daniels praised Rothman for his “exceptional leadership, advancing our clinical, research, and educational missions.

“Conversations with students, faculty, staff, and administrators throughout Johns Hopkins Medicine,” he added, “confirmed our strong belief that Paul possesses and articulates a sharp and nuanced understanding of this institution's role in delivering the highest quality care to patients at home and abroad, producing new discoveries and embracing research agendas that are critical to the health of world, and educating the next generation of premier clinicians and scientists.”

Daniels commended Rothman's commitment to research and discovery amid constrained funding, as well as his support in partnership with fellow deans and directors for early- and mid-career scientists.

Rothman joined Johns Hopkins University in 2012 as the second CEO of Johns Hopkins Medicine and the 14th dean of the School of Medicine.

As dean and CEO, Daniels said, Rothman has:

  • Recruited and appointed leaders across the School of Medicine, in the dean's office, and across the health system
  • Initiated the development and implementation of Johns Hopkins Medicine's first enterprise-wide strategic plan, providing guidance on the shared principles and aspirations that help align and integrate the enterprise
  • Worked closely with Ronald R. Peterson, president of the Johns Hopkins Health System, and other key colleagues to implement key operational changes, including the successful roll the electronic medical records system EPIC, and the smooth transition to the new clinical facilities in the Charlotte R. Bloomberg Children's Center and the Sheik Zayed Tower
  • Made substantial investments in precision medicine while simultaneously developing Centers of Excellence that will apply these principles to medical practice, advancing Johns Hopkins Medicine's potential to fundamentally alter patient outcomes
  • Worked to drive the Bloomberg Distinguished Professorship program, recruiting a cadre of exceptional interdisciplinary researchers and clinicians that is helping to sustain research excellence
  • Supported the 2015 launch of Johns Hopkins Technology Ventures to aid faculty, students, and staff in translating their discoveries into market-ready treatments”Time and again during the reappointment evaluation process, colleagues from across our institution described Paul as the consummate clinician-scientist, a leader who has the skill and vision to see and advance priorities in both research and clinical practice without losing sight of the joy of medicine,” Daniels said. “He is an exemplary partner and colleague, and we are delighted that our health system, our university, and our School of Medicine will benefit from his continued leadership over the next six years.”

Posted in Health, University News

paul rothman


JH SafeRide

The Second Trimester | Johns Hopkins Medicine

The Vehicle Escort Service (VES) program currently serving the Johns Hopkins East Baltimore community is slated to be replaced by JH SafeRide (powered by Lyft). 

  • PHASE 1  – Effective August 1, 2018, the new Lyft-powered service will go into effect as a pilot program for all JHU pre-doctorate students of SOM, SON or JHSPH who live within a 1.5-mile radius of the JH East Baltimore medical campus and meet all eligibility requirements. 

NOTE:  The VES program (powered by the JHMI Transportation fleet) will continue as usual for all other eligible riders.  Any changes will be announced in advance.

JH SafeRide (*JHU Pre-doctorate Students of SOM, SON or JHSPH Only)

JHMI Vehicle Escort Service (*JHU and JHHS Faculty, Staff, Students and Trainees)

*Per each program's eligibility stipulations.

JH SafeRide  (JH-sponsored Lyft service)
 Powered by Lyft

In order to administer the JHSafeRide Program, Johns Hopkins will receive information related to the rides you take under this program from Lyft, which includes but is not limited to your name, the time of your rides, and the pick up and drop off locations.


Who is eligible to use this service?  All JHU pre-doctorate students of SOM, SON or JHSPH who reside within a *1.5 mile radius from the JH East Baltimore medical campus per the home address listed in their school record.

  • Your home address must be within the boundary area and must match the address listed in your school record. 
  • A valid JHED ID is required.
  • A valid JH email address is required (example: “” or “”).
  • Those who do not meet all eligibility requirements cannot use Lyft under the JH-sponsored program. 

* GPS coordinates (radius centerpoint = 601 N. Broadway).

Benefits & Stipulations

  • Up to two (2) Lyft rides daily for a maximum of 42 free rides per calendar month 
  • Pick-up and drop-off locations must be within the established 1.5 mile perimeter and must be to/from a Johns Hopkins East Baltimore campus facility and to/from the home address listed in the student’s school record.
  • You must sign up with Lyft using your Johns Hopkins email address. 
  • Program participants will be responsible for any fees incurred for rides that do not meet the program criteria (no exceptions).  

How to Sign Up

All prospective users must register via the JH SafeRide portal per the instructions below.  All will be vetted for eligibility and must receive notification of approval before using the JH-sponsored Lyft service.   


  • Login to the JH SafeRide portal using your normal JH login information and follow the prompts:
    • JH SafeRide Portal:  
  • You will receive notification of your eligibility status and further instructions if applicable. 
  • Information will be verified to ensure that applicants meet the eligibility requirements. 
  • Those who meet eligibility requirements will be enrolled:
    1. Your JH SafeRide account with Lyft can only be linked to your Johns Hopkins email address.  
    2. Every person who is approved will receive two (2) emails:
      • The first email will come from to confirm approval. 
      • The second email will come from Lyft providing instructions to start using your JH SafeRide credits.  Allow 24 hours to receive this email.  
    3. If you Do Not receive Lyft's instructional email with 24 hours of your initial JH approval email, you will need to submit for assistance as follows:  NOTE:  Approved users will not be able to use the JH SafeRide program benefits until all processing is completed.

For assistance/instruction, always submit your support requests here:   

NOTE:  If you are an active pre-doctoral student registered of SOM, SON or JHSPH​ and your local residence lies within the stipulated 1.5 mile boundary area, please make sure that your local Baltimore *address has been updated in the local address fields provided in the self-serve portal for your school: 

Self-Serve Portals

JH School of Medicine (SOM):
JH School of Public Health (JHSPH):
JH School of Nursing (SON):

Instructions on updating your local address in SIS

Please allow 24 hours for the self-serve updates to synch with the JH SafeRide sign-up portal.  In some cases, JH SafeRide approvals cannot be processed prior to the commencement of your school term.

 *Elligible students who have multiple Hopkins designations in JHED must also update their addresses in SAP.  This can be done via the HR ESS interface by logging into JHED (  For assistance with your address in SAP, contact Human Resources.    

Need Further Assistance?

  • Questions about your student record information? Contact the Registrar's Office for your school.  
  • Questions about your JH SafeRide Lyft account?  Contact Lyft at  
  • Questions about JH SafeRide eligibility or the JH SafeRide portal?   Contact JHMI Transportation Administration at or 410-614-1436.
    • Please include your JHED ID when emailing or leaving a voicemail message.  


JHMI Vehicle Escort Service
 Powered by JHMI Transportation

The current Vehicle Escort Program (VES) powered by JHMI Transportation will remain in service until further notice for all eligible riders. 

Boundary Area

The vehicle escort service provides rides to and from the East Baltimore campus within the pilot boundaries (view map): 

  • Federal Street (north)
  • Eastern Avenue (south)
  • Ellwood Avenue (east) 
  • Harford Road (west)

Request a Ride

Call the Transportation Office at 410-502-6880 and provide the following information:

  • Your name (first and last)
  • Your Johns Hopkins ID badge number
  • Your Johns Hopkins JHED ID
  • Your pick-up and drop-off locations*
  • A telephone number where you can be reached

*The pick-up and drop-off locations must be within the boundaries noted above and must be to or from an East Baltimore campus facility.

Ridership Procedure

When the escort vehicle arrives, please display your valid Johns Hopkins ID badge to the driver prior to entering the vehicle.  Please allow additional time to be picked up or to reach your destination, as our drivers may have other passengers to pick up and drop off along the route.

Escort Vehicles

Escort vehicles can be identified by the blue sign on the front door which displays the Johns Hopkins logo and the words, “CORPORATE SECURITY ESCORT SERVICE.”


Other Information

As a reminder, Corporate Security runs other free courtesy shuttles. For more information on other services, please contact our Transportation Office at 410-502-6880 or visit http://www.hopkinsmedicine.


Don't forget, Corporate Security provides 24/7 walking escorts anywhere within campus boundaries. Please call 410-955-5585 to request a walking escort: http://intranet.insidehopkinsmedicine.




Permanente Scientists Partner with Johns Hopkins Medicine

The Second Trimester | Johns Hopkins Medicine

While delivering excellent health care every day to our patients, Mid-Atlantic Permanente Medical Group (MAPMG) doctors and scientists at the Mid-Atlantic Permanente Research Institute are also working to transform the future of health care through innovative research and collaboration.

Kaiser Permanente and Johns Hopkins Medicine recently awarded a total of $300,000 in grants to four research studies that began in April 2017 and will run through March 2018.

The research is part of a wider effort between the organizations to support the concept of a “health care learning system.

” clinical care data, researchers could innovate new patient health care best practices that improve quality and effectiveness of physicians and medical treatments.

The collaborative studies are:

  1. Racial Disparities in Hypertension (RADISH): Decomposing the Effects of Risk Factor Distribution and Risk Factor Impact on Racial Disparities.
    Principal Investigators: Suma Vupputuri, PhD (Mid-Atlantic Permanente Research Institute) and Romsai Tony Boonyasai, MD (Johns Hopkins)
  2. Evaluating the Uptake of Screening and Preventative Strategies for Patients at High Risk for Breast Cancer.
    Principal Investigators: Kala Visvanathan, MD (Johns Hopkins) and Monica Ter-Minassian, ScD(Mid-Atlantic Permanente Research Institute)
  3. Estimating Changes in Liver Fibrosis Over Time and in Specific Subgroups with Transient Elastography (TE). 
    Principal Investigators: Carla V. Rodriguez, PhD (Mid-Atlantic Permanente Research Institute) and Tinsay Woreta, MD (Johns Hopkins)
  4. Assessing the Relationship between Parental Activation and Obesity-Related Health Behaviors Among Overweight and Obese Low-Income Racial/Ethnic Minority Young Patients.
    Principal Investigators: Nakiya N. Showell, MD (Johns Hopkins) and Deborah Rohm Young, PhD (Southern California Permanente Medical Group)

Peter Pronovost, MD, left, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, with MAPMG Associate Executive Director Bernadette Loftus, MD.

“We are thrilled to be advancing science that will change the way care is delivered across America,” says MAPMG Associate Executive Director Bernadette Loftus, MD. “In less than a year, we have already begun to incorporate our discoveries into practice, and are seeing a meaningful impact on our patients. The future of this research collaboration is incredibly bright.”

These projects mark the second round of studies between Johns Hopkins and Kaiser Permanente. In 2016, three initial studies received more than $200,000 in cooperative grants.

One study looked at how to use electronic health record data to reduce medical errors, while two other studies focused on the quality-of-care and treatment effectiveness of sickle cell disease and the cost-effectiveness of chronic hepatitis C virus treatments.

In 2014, Kaiser Permanente and Johns Hopkins formalized an enhanced strategic collaboration focused on fostering research that will deliver quality health care and potentially change the way medicine is practiced across the nation.

The Johns Hopkins/Kaiser Permanente Research Collaboration Committee (RCC) was launched in 2015, co-chaired by Drs. Loftus and Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine.

“The strength of the science, the innovation of new treatment interventions, and our ability to leverage our integrated care systems to support these research efforts are truly breathtaking,” said Dr. Pronovost. “These projects will help spur innovation, deliver new knowledge and, most importantly, expedite new quality patient benefits from this knowledge to improve their outcomes.”

More information about the collaboration and members of the RCC can be found at

This article originally appeared on the MAPMG website.


The Second Trimester

The Second Trimester | Johns Hopkins Medicine

Linkedin Pinterest What You Need to Know

  • During your second trimester prenatal visits, your health care provider will continue to check on your and your baby’s health, including monitoring the fetal heartbeat.
  • The second trimester is the most physically enjoyable for most women. Morning sickness usually lessens by this time, and the extreme tiredness and breast tenderness usually ease up.
  • Your fetus has now developed all its organs and systems and will now begin to grow in length and weight.
  • You may be able to feel the movement of the fetus for the first time at around 20 weeks. This phenomenon is called quickening.
  • A fetus born at the end of 24 weeks may survive in a neonatal intensive care unit.

During your second and third trimester prenatal visits, your health care provider may check the following, depending on your current medical condition and the health of the fetus:

  • Any current symptoms or discomforts
  • Your weight
  • Your blood pressure
  • Urine test. This is done to find albumin, a protein that may indicate pre-eclampsia or toxemia, and glucose (which may indicate hyperglycemia).
  • Growth, size and development of the fetus
  • Size of the uterus. After approximately 12 weeks of gestation, the uterus can be felt through the abdominal wall.
  • Height of the fundus (top of the uterus), starting at 20 weeks of gestation
  • Fetal heartbeat

The Second Trimester: What to Expect

The second trimester marks a turning point for the mother and 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.

During the second trimester, the umbilical cord continues to thicken as it carries nourishment to the fetus. However, harmful substances also pass through the umbilical cord to the fetus, so care should be taken to avoid alcohol, tobacco and other known hazards.

During the second trimester, both your body and the fetus continue to grow.

The Baby-Friendly Hospital Initiative, a global program launched by the World Health Organization and the United Nations Children’s Fund, has designated The Johns Hopkins Hospital as Baby-Friendly. This designation is given to hospitals and birthing centers that offer an optimal level of care for infant feeding and mother-baby bonding.

The second trimester is the most physically enjoyable for most women. Morning sickness usually lessens by this time, and the extreme tiredness and breast tenderness usually ease up. These changes can be attributed to a decrease in levels of human chorionic gonadotropin hormone and an adjustment to the levels of estrogen and progesterone hormones.

The following is a list of changes and symptoms that may happen during the second trimester:

  • Appetite may increase.
  • You may be able to feel the movement of the fetus for the first time around 20 weeks. This phenomenon is called quickening.
  • The uterus grows to the height of the bellybutton around 20 weeks, making the pregnancy visible.
  • The skin on the belly may itch as it grows, and there may be pain down the sides of the body as the uterus stretches. The lower stomach may ache as ligaments stretch to support the uterus.
  • The need to urinate often may decrease as the uterus grows the pelvic cavity, relieving pressure on the bladder.
  • Your nose may become congested, and you may experience nosebleeds. This is due to the increase in hormones (estrogen and progesterone) and blood flow that affect the mucous membranes and blood vessels in the nose.
  • Your gums become spongier and may bleed easily. This is due to the increase in hormones (estrogen and progesterone) that affect the mucous membranes in the mouth.
  • Varicose veins and hemorrhoids may appear.
  • You may have a white-colored vaginal discharge called leukorrhea. (A colored or bloody discharge may signal possible complications and should be examined immediately.)
  • The increasing weight gain may cause backaches.
  • Skin pigmentation may change on the face or abdomen due to the pregnancy hormones.
  • Heart burn, indigestion and constipation may continue.

The Second Trimester: Fetal Development 

Now that all the major organs and systems have formed in the fetus, the following six months will be spent growing. The weight of your fetus will multiply more than seven times over the next few months, as the fetus becomes a baby that can survive outside of the uterus.

By the end of the second trimester, your fetus will be about 13 to 16 inches long and weigh about 2 to 3 pounds. Fetal development during the second trimester includes the following:

  • The fetus kicks, moves and can turn from side to side.
  • The eyes have been gradually moving to the front of the face, and the ears have moved from the neck to the sides of the head. The fetus can hear your voice.
  • A creamy white substance (called vernix caseosa, or simply vernix) begins to appear on the fetus and helps to protect the thin fetal skin. Vernix is gradually absorbed by the skin, but some may be seen on babies even after birth.
  • The fetus is developing reflexes, swallowing and sucking.
  • The fetus can respond to certain stimuli.
  • The placenta is fully developed.
  • The brain will undergo its most important period of growth from the fifth month on.
  • Fingernails have grown on the tips of the fingers and toes, and the fingers and toes are fully separated.
  • The fetus goes through cycles of sleep and wakefulness.
  • Skin is wrinkly and red, covered with soft, downy hair (called lanugo).
  • Hair is growing on the head of the fetus.
  • Fat begins to accumulate in the fetus.
  • Eyelids are beginning to open, and the eyebrows and eyelashes are visible.
  • Fingerprints and toeprints have formed.
  • Rapid growth is continuing in fetal size and weight.
  • The 20th week marks the halfway point of the pregnancy.

A fetus born at the end of 24 weeks may survive in a neonatal intensive care unit.


Suspicion still simmers just under the surface

The Second Trimester | Johns Hopkins Medicine

For decades, residents of the poor neighborhood surrounding Johns Hopkins Hospital have had an uneasy relationship with the billion-dollar institution at its center. They viewed it as elitist, more interested in medical research than in their care.

While the hospital has worked to enhance relations, spending millions on community support and to serve poor patients, recent controversy over a study conducted by the Johns Hopkins Bloomberg School of Public Health and the Kennedy Krieger Institute has illuminated historical tensions.

In 2000, researchers spread fertilizer made from a combination of human and industrial wastes on the lawns of nine East Baltimore homes in an effort to help combat lead poisoning. Hopkins says the fertilizer was a common, commercially available compost that did effectively mitigate lead and that participants and the community were fully informed.

But the National Association for the Advancement of Colored People has called for state and federal officials to launch a criminal investigation, saying the study could be viewed as an experiment conducted at a cost to the health of the mostly poor, black families living in the area. Maryland lawmakers have urged the U.S. Department of Housing and Urban Development to investigate why it funded the study.

“This particular story about the sludge unfortunately adds to the continuing distrust of Hopkins,” said Michael Eugene Johnson, state director of the Black United Fund, which has joined forces with the NAACP on the issue. “This may be an honest, proper study that was done, but the shroud of secrecy, the fact that information is not being shared, it has revived this concern.”

Johnson said some people living in the shadow of Hopkins remain wary of the institution, even while recognizing it as a premier research hospital.

“It's always been known as Johns Frankenstein to a lot of us, even though we are well aware that Johns Hopkins is one of the finest research institutions in the world,” he said. “People would say, 'Don't go past there at night, you might come up missing.'”

Homer E. Favor remembers reluctantly carrying his 3-year-old son to the emergency room at Johns Hopkins Hospital.

It was 1960, and a father's fears were exacerbated by the fact that blacks and whites were treated in separate wards. Worse, were the unfounded rumors that circulated among Favor's friends and neighbors: at Hopkins they made guinea pigs black patients.

His son received life-saving surgery to remove his appendix, and over the years, Favor became good friends with some of Hopkins' most respected doctors and administrators.

But the “ghost stories” among some African-Americans about medical research at Hopkins and other research institutions in minority communities remain.

“There are still people I know who say, 'Don't take me to Hopkins. … Something bad is going to happen to me there,'” said Favor, 84, a civil rights activist and retired dean at Morgan State University, who has lived in the East Baltimore community near Hopkins for more than 40 years.

African-American skepticism of medical research was inflamed in the infamous Tuskegee Study, in which researchers for the U.S. Public Health Service allowed syphilis in black men in Alabama to go untreated.

The study, begun in the 1930s, continued for 40 years. Hopkins was not involved in that study, but the incident contributed to widespread suspicions about medical research in general.

When Dr. Levi Watkins Jr. arrived at Hopkins 38 years ago, the hospital had only recently become integrated, abandoning the practices of separate wards, blood banks, morgues and cafeterias for blacks and whites. He and other interns and residents lived in buildings encircled by a fence, designed to keep the local – mostly black – community out, he said.

It was not what Johns Hopkins himself had envisioned. In a letter to trustees upon founding the institution, Hopkins urged the hospital to be inclusive of minorities and the poor, making service to these groups a crucial part of its mission, Watkins said.

In fact, the second patient admitted to the hospital when it opened in 1889 was an African-American. That was a time when many other hospitals in Baltimore did not admit blacks.

“The problem with that was America,” said Watkins, associate dean at the Johns Hopkins University School of Medicine and a professor of cardiac surgery, who has made diversity at the institution his mantra. “We were giants in medicine, not so giant in humanitarian efforts as much as race was concerned, even though Mr. Hopkins had instructed us to be so.”

Watkins maintains Hopkins has worked to ease community discomfort. The hospital has 82 community programs designed to engage the neighborhood, examining such issues as teen pregnancy prevention, sickle cell anemia and crime and violence, he said.

Officials also noted that Johns Hopkins Hospital, as well as the School of Public Health, have devoted significant resources to East Baltimore and the city overall.

In fiscal year 2007, the institution gave $100 million in community benefits, according to Hopkins spokesman Gary Stephenson. The hospital provided $146 million in uncompensated care – typically care for poor, uninsured patients.

Stephenson said the “vast majority of this care went to Baltimore City residents.”

“Johns Hopkins is deeply committed to its community and it has supported that community with money, resources and time,” Stephenson said.

He said Johns Hopkins has never been involved in a Tuskegee- study, in which subjects were harmed or otherwise exploited. And Watkins defended Bloomberg researchers, saying he is certain they had no racial motives.

“The problem however, is the sensitivity of it,” Watkins said.

Bloomberg Dean Dr. Michael Klag agreed that the black community had historical grounds for suspicion about researchers' motives. But Klag said the institution has a “pretty good relationship with the surrounding community.”

And he said the researchers had worked closely with community groups to set up the study and make sure it was done ethically.

“It was done as it should have been done,” he said.

The study's leader author, Mark Farfel, a former associate professor at the Kennedy Krieger Institute and Bloomberg, has been the subject of favorable and unfavorable press over the years.

In 2001, the Court of Appeals ned a lead paint study Farfel had conducted years before to the Tuskegee experiments.

Farfel's study was an attempt to identify an affordable measure that could reduce the danger of lead-paint poisoning faced by children living in old homes.

The study focused on more than 100 families who were enticed to live in homes that had varying levels of partial lead abatement as part of a study of whether cheaper methods of containing lead would keep the toxin children's bodies.

In reversing a lower court decision dismissing the suit, the Court of Appeals found researchers failed to warn families that their children faced a health risk if they continued to live in the homes. The court also found that the researchers did not inform the families of the youngsters' elevated blood-lead levels in a timely way.

Klag argued that in the compost study, the researchers were actually trying to help the community, not exploit it. “It was done in East Baltimore because we were having an epidemic of lead poisoning there,” he said. “The study was done in response to the needs of the community.”

Klag said he didn't think most people in East Baltimore felt alienated from Hopkins: “By and large, people are worried about getting a good education for their kids, having a good job. I don't think they have a lot of hostility directed toward the hospital. Many people recognize that Hopkins does a lot of good things in the community.”

However, Hopkins and the East Baltimore Community Development Inc. have been criticized for clearing dozens of acres and displacing residents to make way for an $800 million biotechnology park.

Donald Gresham, president of the Save Middle East Action Committee, which represents homeowners, said the hospital has not done enough for the community.

“Most people's impression is they are really hurt and disappointed,” Gresham said. “Most people in East Baltimore were born at Johns Hopkins. Their doctor is at Johns Hopkins. The community is not happy about what Johns Hopkins is doing.”

Dr. Al Sommers, who was dean at JHSPH from 1990 to 2005, said decades-long tensions have eased significantly in recent years.

Klag, Sommers argued that Hopkins has helped East Baltimore. “Hundreds if not thousands of people in East Baltimore work there. Hopkins has been an engine for jobs, employment, education, for people bettering themselves,” he said.

Battling community suspicion is not unique to Hopkins but is an issue that research institutions nationwide face, said Watkins.

“There is distrust here as there is of most research institutions in communities of color. This is an American issue,” he said. “I don't hear the kinds of concerns I used to, but that doesn't mean that people don't still believe them.”

Staff reporters Stephen Kiehl and Dennis O'Brien contributed to this article.


The First Trimester

The Second Trimester | Johns Hopkins Medicine

Linkedin Pinterest What You Need to Know

  • At your first prenatal visit, you will undergo a physical exam as well as certain tests and screenings to assess the health of you and your unborn baby.
  • First trimester symptoms vary from woman to woman, with some experiencing all known symptoms and others only a few. Duration of symptoms can vary as well.
  • After eight weeks, the embryo is referred to as a fetus.
  • Although the fetus is only 1 to 1.

    5 inches long at this point, all major organs and systems have been formed.

  • During the first trimester, the fetus is most susceptible to damage from substances, alcohol, drugs and certain medicines, and illnesses, rubella (German measles).

Your first prenatal visit is the most thorough.

A complete medical history is taken, a physical exam is done, and certain tests and procedures are performed to assess the health of both you and your unborn baby. Your first prenatal visit may include:

  • Personal medical history. This may include taking record of any of the following:

  • Maternal and paternal family medical history, including illnesses, intellectual or developmental disabilities, and genetic disorders, sickle cell disease or Tay-Sachs disease

  • Personal gynecological and obstetrical history, including past pregnancies (stillbirths, miscarriages, deliveries, terminations) and menstrual history (length and duration of menstrual periods)

  • Education, including a discussion regarding the importance of proper nutrition and expected weight gain in pregnancy; regular exercise; the avoidance of alcohol, drugs and tobacco during pregnancy; and a discussion of any concerns about domestic violence

  • Pelvic exam. This exam may be done for one or all of the following reasons:

    • To note the size and position of the uterus

    • To determine the age of the fetus

    • To check the pelvic bone size and structure

    • To perform a Pap test (also called Pap smear) to find the presence of abnormal cells

  • Lab tests, including the following:

    • Urine tests. These are done to screen for bacteria, glucose and protein.

    • Blood tests. These are done to determine your blood type.

      • All pregnant women are tested for the Rh factor during the early weeks of pregnancy. Rh incompatibility happens when the mother’s blood is Rh-negative, the father’s blood is Rh-positive and the fetus’ blood is Rh-positive.

        The mother may make antibodies against the Rh-positive fetus, which may lead to anemia in the fetus. Incompatibility problems are watched and appropriate medical treatment is available to prevent the formation of Rh antibodies during pregnancy.

        There are also other blood antibodies that may cause problems in pregnancy that are screened for on the first visit.

  • Blood screening tests. These are done to find diseases that could have an effect on the pregnancy. One example is rubella, an infectious disease that is also called German measles.

  • Genetic tests. These are done to find inherited diseases, sickle cell disease and Tay-Sachs disease.

  • Other screening tests. These are performed to find infectious diseases, sexually transmitted diseases and urinary tract infections.

The first prenatal visit is also an opportunity to ask any questions or discuss any concerns that you may have about your pregnancy.

The First Trimester: What to Expect

A healthy first trimester is crucial to the normal development of the fetus. You may not be showing much on the outside yet, but on the inside, all of the major body organs and systems of the fetus are forming.

As the embryo implants itself into the uterine wall, several developments take place, including the formation of the:

  • Amniotic sac. A sac filled with amniotic fluid, called the amniotic sac, surrounds the fetus throughout the pregnancy. The amniotic fluid is liquid made by the fetus and the amnion (the membrane that covers the fetal side of the placenta) that protects the fetus from injury. It also helps to regulate the temperature of the fetus.

  • Placenta. The placenta is an organ shaped a flat cake that only grows during pregnancy. It attaches to the uterine wall with tiny projections called villi. Fetal blood vessels grow from the umbilical cord into these villi, exchanging nourishment and waste products with your blood. The fetal blood vessels are separated from your blood supply by a thin membrane.

  • Umbilical cord. The umbilical cord is a rope cord connecting the fetus to the placenta. The umbilical cord contains two arteries and a vein, which carry oxygen and nutrients to the fetus and waste products away from the fetus.

It is during this first trimester that the fetus is most susceptible to damage from substances, alcohol, drugs and certain medicines, and illnesses, rubella (German measles).

During the first trimester, your body and your baby’s body are changing rapidly.

The Baby-Friendly Hospital Initiative, a global program launched by the World Health Organization and the United Nations Children’s Fund, has designated The Johns Hopkins Hospital as Baby-Friendly. This designation is given to hospitals and birthing centers that offer an optimal level of care for infant feeding and mother-baby bonding.

During pregnancy, many changes will happen to your body to help nourish and protect your baby. Women experience these changes differently. Some symptoms of pregnancy continue for several weeks or months.

Others are only experienced for a short time. Some women experience many symptoms, and other women experience only a few or none at all.

The following is a list of changes and symptoms that may happen during the first trimester:

  • The mammary glands enlarge, causing the breasts to swell and become tender in preparation for breast-feeding. This is due to an increased amount of the hormones estrogen and progesterone. A supportive bra should be worn.

  • Your areolas (the pigmented areas around each breast’s nipple) will enlarge and darken. They may become covered with small, white bumps called Montgomery’s tubercles (enlarged sweat glands).

  • Veins become more noticeable on the surface of your breasts.

  • The uterus is growing and begins to press on your bladder. This causes you to need to urinate more often.

  • Partly due to surges in hormones, you may experience mood swings similar to premenstrual syndrome, a condition experienced by some women that is characterized by mood swings, irritability and other physical symptoms that happen shortly before each menstrual period.

  • Increased levels of hormones to sustain the pregnancy may cause “morning sickness,” which causes nausea and sometimes vomiting. However, morning sickness does not necessarily happen just in the morning and rarely interferes with proper nutrition for the mother and her fetus.

  • Constipation may happen as the growing uterus presses on the rectum and intestines.

  • The muscular contractions in the intestines, which help to move food through the digestive tract, are slowed due to high levels of progesterone. This may, in turn, cause heartburn, indigestion, constipation and gas.

  • Clothes may feel tighter around the breasts and waist, as the size of the stomach begins to increase to accommodate the growing fetus.

  • You may experience extreme tiredness due to the physical and emotional demands of pregnancy.

  • Cardiac volume increases by about 40 to 50 percent from the beginning to the end of the pregnancy. This causes an increased cardiac output. An increased cardiac output may cause an increased pulse rate during pregnancy. The increase in blood volume is needed for extra blood flow to the uterus.  

The First Trimester: Fetal Development

The most dramatic changes and development happen during the first trimester. During the first eight weeks, a fetus is called an embryo. The embryo develops rapidly and by the end of the first trimester, it becomes a fetus that is fully formed, weighing approximately 0.5 to 1 ounce and measuring, on average, 3 to 4 inches in length.

First Trimester Fetal Growth and Development Benchmarks

The chart below provides benchmarks for most normal pregnancies. However, each fetus develops differently.

Timing Development Benchmark
By the end of four weeks
  • All major systems and organs begin to form.
  • The embryo looks a tadpole.
  • The neural tube (which becomes the brain and spinal cord), the digestive system, and the heart and circulatory system begin to form.
  • The beginnings of the eyes and ears are developing.
  • Tiny limb buds appear, which will develop into arms and legs.
  • The heart is beating.
By the end of eight weeks
  • All major body systems continue to develop and function, including the circulatory, nervous, digestive, and urinary systems.
  • The embryo is taking on a human shape, although the head is larger in proportion to the rest of the body.
  • The mouth is developing tooth buds, which will become baby teeth.
  • The eyes, nose, mouth, and ears are becoming more distinct.
  • The arms and legs can be easily seen.
  • The fingers and toes are still webbed, but can be clearly distinguished.
  • The main organs continue to develop and you can hear the baby's heartbeat using an instrument called a Doppler.
  • The bones begin to develop and the nose and jaws are rapidly developing.
  • The embryo is in constant motion but cannot be felt by the mother.
From embryo to fetus
  • After 8 weeks, the embryo is now referred to as a fetus, which means offspring.
  • Although the fetus is only 1 to 1.5 inches long at this point, all major organs and systems have been formed.
During weeks nine to 12
  • The external genital organs are developed.
  • Fingernails and toenails appear.
  • Eyelids are formed.
  • Fetal movement increases.
  • The arms and legs are fully formed.
  • The voice box (larynx) begins to form in the trachea.

The fetus is most vulnerable during the first 12 weeks. During this period of time, all of the major organs and body systems are forming and can be damaged if the fetus is exposed to drugs, infectious agents, radiation, certain medications, tobacco and toxic substances.

Even though the organs and body systems are fully formed by the end of 12 weeks, the fetus cannot survive independently.