Third Trimester Education

Aka: Third Trimester Education, Pregnancy Education in the Third Trimester

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II. Symptoms

  1. Anticipated Discomforts
    1. Cramps
    2. Foot Edema
    3. Urinary Frequency
  2. Symptoms prompting urgent evaluation
    1. Signs of labor
      1. Nulliparous: SROM or Contractions q5' for 1 hour
      2. Multiparous: SROM or Contractions q8' for 1 hour
    2. Preterm Labor
      1. More than 4 contractions in 1 hour
    3. Spontaneous Rupture of Membranes (SROM)
    4. Vaginal Bleeding
    5. Signs of Pregnancy Induced Hypertension (PIH)

III. Labs: 32-36 weeks gestation

  1. Obstetric Ultrasound as needed
    1. Fetal Position
    2. Fetal Assessment (e.g. Biophysical Profile)
  2. Cervical Examination
  3. Group B Streptococcus Culture at 36 weeks
    1. Indicated as routine screening if not already done
  4. Hemoglobin
    1. Indicated for monitoring Anemia in Pregnancy
  5. Urinalysis and Urine Culture
    1. Indicated monitoring prior Urinary Tract Infection
  6. Re-screen for Sexually Transmitted Disease if at risk
    1. Syphilis Serology
    2. Chlamydia screen
    3. Gonorrhea Culture
  7. Re-screen Glucose Challenge Test at 32 weeks if at risk

IV. Management

  1. See Nutrition in Pregnancy
  2. See Travel in Pregnancy
  3. See Exercise in Pregnancy
  4. Immunizations
    1. Influenza Vaccine if pregnant in Influenza season
    2. Diphtheria and Pertussis Vaccination (Tdap Vaccine)
      1. Given at 27 to 36 weeks in each pregnancy
      2. Allows for passive Immunity for newborns
      3. (2017) Obstet Gynecol 130(3): e153-7 [PubMed]
  5. Discussion points
    1. Contraception
    2. Circumcision
    3. Child birth class (optional)
      1. Does not appear to modify labor experience or outcomes
    4. Non-Pharmacologic Pain Control in Labor
    5. Labor Analgesia and Anesthesia

V. References

  1. Ramirez (2023) Am Fam Physician 108(2): 139-50 [PubMed]

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