Third Trimester Prenatal Care 

Introduction:

The third trimester is 24 weeks and forward. It is a time when you begin to really grow. Appetite increases and weight gain ramps up. The baby's movements really start to become strong. Baby is now developed enough to survive in newborn intensive care unit. This is the time to begin your prenatal education in earnest, by attending classes on labor, delivery, breastfeeding, infant care, and the like. It is also time to finalize your nursery preparations for the baby. 

 

Common third trimester symptoms:

Abdominal wall stretching

Fatigue at the end of the day

Laxity of the joints resulting in unpleasant hip sensations, Sciatica, and round ligament strain

Insomnia

Heartburn

Nighttime leg cramps

 

Common third trimester problems:

Hypertensive disorders of pregnancy such as preeclampsia, or toxemia 

Preterm labor 

Abnormalities of Amniotic fluid 

Abnormalities of fetal growth 

 

Prenatal appointments:

Appointments are always tailored to need. However during the third trimester, they become more and more frequent.

24 to 32 weeks –appointments every four weeks unless otherwise indicated

32 to 36 weeks – appointments every two weeks unless otherwise indicated

36 weeks to term–appointments at least weekly

Your third trimester visits and screening tests: 



28 weeks 

 

 

 

 

 

 

 

 

 

 

35 weeks 

 

 

 

 

36 weeks plus

 

 

 

 

 

 

24-41 weeks

 

 

 

 

 

37 weeks forward 

 

 

 

 

This appointment usually takes longer than the standard OB appointment since the following procedures are done.

  1. The test for gestational diabetes takes place at this time. It is a provocative sugar test which requires you to drink a prespecified sugar load and then be tested to see how well your body metabolizes the sugar.
  2. There is also a test for an anemia. 
  3. Antibodies in blood are retested.
  4. Desires for possible sterilization are discussed at this time and consent papers can be signed.
  5. A cervical exam is often done on a routine basis at this appointment.
  6. Finally if you have Rh negative blood type, You are given a RhoGAM shot to prevent any bad reactions between your immune system and the blood of the baby you carry.

 

Screening for group B strep or GBS is done at this time. Group B strep is a common bacteria that colonizes the general track of about 20% of all women. Group B strep rarely causes infections in healthy non-pregnant women. However, it can cause serious disease if it passes to the newborn. It is reassuring to note that with universal group B strep  screening and appropriate treatment, Group B strep disease is rarely a problem.

 

Cervical exams are performed as needed during this timeframe. Care is taken to confirm that the baby is head down. If there is suspicion that this is not the case, ultrasound can be performed to confirm. If the baby is not head down and is transverse or breech instead, then consideration can be given to a procedure called a version, which involves the doctor physically rotating the baby so that the baby is headdown. This is done at the hospital with the benefit of monitoring and ultrasound.

 

Anytime during this time frame external fetal monitoring can be done to confirm the babies well-being. External fetal monitoring can take place in labor and delivery. It is accomplished by putting two belts on the abdomen of the mother. One is to monitor the heart rate of the baby in the other is to monitor uterine activity such as contractions. This data can be read out on a monitor that can be evaluated by the nurse or doctor.

Anytime during the entire pregnancy, ultrasound ay be repeated to check on the status of the pregnancy. 

Time to prepare for labor or rupture of membranes. Time to pack your bags !