Week 18 of pregnancy: First Flutters

This is usually the week the detailed mid-pregnancy scan becomes possible. In India it is often called the level II, anomaly or TIFFA scan and is commonly done between 18 and 22 weeks; it looks carefully at your baby's organs, growth and the placenta. Your baby is now covered in fine hair and movements are strengthening, so some people feel first flutters. For you, blood pressure normally dips in mid-pregnancy, which can make you dizzy when you stand quickly. Plan the scan, and give yourself time to get up slowly.

Your baby is roughly 13–14 cm from crown to rump this week, and estimated weights of about 190–240 g are typical. These are averages from reference charts, not targets. A bell pepper gives a rough idea only; your own scan report may show a slightly different figure and still be normal.

Every pregnancy is different - you may have some, all or none of these.

Dizziness on standing

Blood pressure naturally dips now. Stand up in stages, drink enough fluids, eat regularly and avoid long, still standing. Fainting, or dizziness with a headache or blurred vision, needs a medical review.

Back ache

Hormones soften the ligaments supporting your spine. Change position often and avoid lifting. Back pain with fever or painful urination should be checked the same day.

First movements

Light flutters, bubbles or taps are how many people describe them. If you have not felt anything yet, that is common before 20–24 weeks, especially in a first pregnancy.

Blocked nose or nosebleeds

Pregnancy rhinitis often lasts through the middle months. Many cold remedies contain ingredients to avoid, so ask a pharmacist before using one.

Frequent urination

Pressure from the uterus on the bladder is common. Burning, stinging or cloudy urine is not normal and may be an infection.

• Anomaly scan (level II / TIFFA)

  Commonly offered

  India usually 18 to 22 weeks; UK 18+0 to 20+6 weeks; US 18 to 22 weeks

  A detailed ultrasound of your baby's anatomy, growth, the amount of fluid and where the placenta lies. It is offered to everyone in the UK and US; in India it is widely done, although ultrasound access in the public sector varies. If something looks unusual, you may be referred for a specialist fetal medicine scan, a fetal heart scan (echo) or a diagnostic test. No scan can detect every condition.

• Legal rules on scans in India

  Routine

  Every ultrasound in pregnancy

  Under the PCPNDT Act, the clinic must fill Form F for each pregnancy scan, and it is illegal for anyone to tell you your baby's sex, by words, signs or any other means. The anomaly scan will not tell you the sex, and you should not ask.

• Early anatomy scan if you have diabetes

  Only if needed

  18 to 20 weeks

  If gestational diabetes was diagnosed before 20 weeks, India's national guidance recommends an anatomy scan at 18–20 weeks.

The exact week of the scan depends on your doctor and the centre. Take your previous scan and blood reports with you, and allow time: a thorough scan can take a while, and you may be asked to walk around if the baby's position makes some views difficult.

• 🌿Calcium is this week's focus. India's dietary guidance for pregnancy includes about 400 ml of milk or curd a day; dahi, chaas, milk and paneer are easy ways to get there.
• 🌿If you avoid or cannot tolerate dairy, lean on ragi (as roti, dosa or porridge), til chutney or til laddoo in small amounts, rajgira, and green leafy vegetables.
• 🌿Take your calcium tablets with food, never on an empty stomach and never alongside the iron tablet, as India's calcium guidelines advise.
• 🌿Regular meals and snacks also help with dizziness. A handful of roasted chana or a banana in your bag can stop you going too long without food.

• •Walking, swimming and prenatal yoga remain good choices. Rise slowly at the end of any floor session, rolling onto your side first.
• •If you feel dizzy while exercising, stop, sit or lie on your side and have some water. Avoid hot rooms and hot yoga, which make dizziness more likely.
• •Avoid long periods lying flat on your back, which can also bring on dizziness; switch to side-lying or supported, propped-up positions instead.

• •Take someone with you to the scan if you would like support, but check the centre's rules on companions.
• •Ask for a copy of the scan report and keep it with your antenatal card; later doctors may need it.
• •If you work on your feet all day, ask whether you can sit for part of the shift, and move your legs often when you do stand.
• •Be wary of anyone offering to reveal the baby's sex or promising special scans for a fee. This is illegal in India, and genuine clinics will refuse.

• ?Which parts of my baby's anatomy will the scan check, and what can it not see?
• ?When will I get the report, and who will explain it to me?
• ?Where is my placenta lying?
• ?If something needs a second look, how quickly can a follow-up scan be arranged?
• ?Is my blood pressure low enough to explain my dizziness?

• Anomaly scan appointment confirmed
• Previous scan and blood reports packed for the visit
• Antenatal card or MCP card up to date
• Water bottle and snack in your bag
• Calcium tablets taken with meals, apart from iron