Third Trimester of pregnancy-Medcall(Hindi) Care Plan
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Taking care of a woman when she is pregnant till she gives birth to a baby is called the prenatal care.
The total duration of pregnancy is 40 weeks and it starts from day 1 of your previous menstrual cycle. A normal pregnancy comprises of 3 trimesters where the first trimester starts from the time your baby is conceived and runs through week 14 of your pregnancy.
The third trimester of your pregnancy starts from week 28 and goes through week 40. Your doctor might speak to you in terms of weeks rather than months.(1)
In your third trimester, you will have a prenatal visit every 15 days until 36 weeks and weekly thereafter till you deliver your baby. These visits are usually quick and are very important. During your visits, your doctor will do a physical examination; you will have to get an ultrasound and some laboratory tests done.
You can also discuss with your doctor if you have any concerns or issues.
Physical examination: During this visit your doctor will check your weight, blood pressure and your overall health status. Your doctor will also examine and measure your abdomen to see if your baby is growing as expected.
As your due date approaches, your prenatal visits might include pelvic exams. These are done to check the baby's position and detect cervical changes. If the baby's position is head down then you need not worry. But if the baby is in any other position then intervention may be required.
As your body prepares for birth, your cervix will begin to soften, open (dilate) and thin (efface). This will be noted by your doctor during pelvic examination.(1),(2)
Laboratory tests: Blood tests will be done to check your
Hemoglobin: This measures the amount of red blood cells in your blood.
Urine analysis for signs of bladder, urinary tract or kidney infection. Also urine sugar and protein analysis will be done to rule out Gestational diabetes and high blood pressure changes.
In routine, no other lab tests are done, but certain lab tests may be required in cases of
high-risk pregnancy, such as when the baby is not growing
you have a health problem, such as diabetes or high blood pressure
you had complications (problems) in a prior pregnancy
you are overdue (pregnant for more than 40 weeks)
Ultrasound: An ultrasound may be done in third trimester
To determine the baby's age, growth, position
Identify any developmental problems
Look for multiple pregnancies (twins, triplets, etc.)
Look at the placenta, amniotic fluid, and pelvis(3)
Symptoms and signs during third trimester of pregnancy
The common signs and symptoms seen during third trimester of pregnancy are:
1.Backache: Backache is due to the extra weight that you have gained during pregnancy. You may feel achy, sore and discomfort in your pelvis and hips as your ligaments loosen to prepare for labour. To ease the pressure on your back, practice good posture, sit up straight and use a chair that provides good back support. At night, sleep on your side with a pillow tucked between your legs. Wear low-heeled, comfortable shoes with good arch support. To relieve back pain, use a heating pad.
2. Braxton Hicks contractions: mild contractions, which are warm-ups to prepare your uterus for the real labour to come, may be felt. They are not as intense as real labour contractions, but they may feel a lot like labour and can eventually progress to it. One main difference is that real contractions gradually get closer and closer together and become more intense.
3. Breast enlargement. By the end of your pregnancy, your breasts will have grown by as much as 2 pounds. So wear a supportive bra. Clear, yellowish fluid called colostrum may be seen from the nipples nearing the due date.
4. Discharge: Vaginal discharge may be more during the third trimester.
5. Fatigue: Carrying extra weight, waking up several times during the night to go to the bathroom, and dealing with the anxiety of preparing for a baby can all take a toll on your energy level. When you feel tired, try to take a nap, or at least sit down and relax for a few minutes.
6. Frequent urination: The baby's head may be pressing down on your bladder increasing the frequency of urination, sometimes even in the night. You might also find that you are leaking urine when you cough, sneeze, laugh, or exercise. To relieve the pressure and prevent leakage, empty your bladder whenever you feel the urge.
7. Heartburn and constipation: These symptoms are caused by extra production of the hormone progesterone, which relaxes certain muscles including the muscles in your esophagus/food pipe that normally keep food and acids down in your stomach, and the ones that move digested food through your intestines.
8. Hemorrhoids: Hemorrhoids are actually swollen veins that form around the anus. These veins enlarge during pregnancy because extra blood is flowing through them and the weight of pregnancy increases the amount of pressure to the area. To relieve the itch and discomfort, try sitting in a warm tub or sitz bath.
9. Shortness of breath. As your uterus expands, it puts pressure on your rib cage, restricting the normal expansion of your lungs which leads to difficulty in breathing.
10. Spider and varicose veins: The excess blood flow the your circulation is sending to your baby can cause tiny red veins, known as spider veins, to appear on your skin which fade once your baby is born. Pressure on your legs from your growing baby may also cause some surface veins in your legs to become swollen and blue or purple. These are called varicose veins. You can prevent them from getting worse by
Getting up and moving throughout the day
Wearing support hose
Propping up your legs whenever you have to sit for long periods of time.
11. Swelling. Mild swelling in your legs is as the result of excess fluid retention. To reduce swelling, put your feet up on a stool or box whenever you sit for any length of time, and elevate your feet while you sleep.(6)
Care of breast and nipple during pregnancy As breast and nipple undergo continuous change throughout the pregnancy, taking care of them forms an important part of prenatal care. Some of the tips are-
Make sure you wear a right sized bra, so that you do not develop stretch marks. Since the size of breast continue to increase take care to change the bra accordingly.
Avoid wearing under-wired bras, as they might hamper the functioning of the milk glands. Never wear a very tight bra.
The nipple might become too rough and might develop cracks. Lightly massage your nipples with coconut oil to reduce this problem.
Sometimes you may develop inverted nipples. So gently pull out the nipples, so that by the time the child is born the nipples are in correct position. This is one of the important breast care tip that has to be followed during pregnancy.
Towards the last few weeks you may notice a clear yellow fluid that is the colostrum coming out of your nipple. Clean it regularly or else it may lead to infection.Contact your doctor regarding same. (6),(7)
Schedule for Consultations/Diagnostic tests: During the third trimester you will have to visit your doctor every 15 days until 36 weeks and weekly thereafter. Continue the iron and calcium tablets as prescribed.
If you have not received the second dose of tetanus toxoid injection or you have not received even one dose during your pregnancy, then it will be given in third trimester.
Continue to walk even during third trimester. It gives you some physical activity. Take care of your posture will walking. You can also continue breathing exercises. This helps you to relieve stress and discomfort.
Exercises to avoid: It is best to avoid exercises that involve extreme stretches or high-impact activities like aerobics and running that put a lot of stress on your joints and put you at risk for falls. Since the joints are loosened during pregnancy in preparation for a growing baby, labour, and delivery, you are at more risk for strains and sprains.
Leg lifts, back bends, lying on the belly, and poses that stress the abdomen or pelvic floor should also be avoided
Stop exercises if you experience dizziness or light-headedness, headache, nausea or vomiting, overheating or dehydration, unusual vaginal discharge or bleeding, belly pain, lower back pain and fatigue. Call your doctor if these symptoms do not settle within 15 minutes of stopping exercise.(11)
To prevent mild dizziness, avoid prolonged standing. Also rise slowly after lying or sitting down.
If you feel dizzy while driving, then pull over to one side.
You may feel overheated easily. So wear clothes made of natural fibres and avoid synthetic ones.
Stay active and continue your normal activities during pregnancy
Use sunscreens when you go outdoors as skin pigmentation increases on sun exposure.
Use moisturizers over the stretch marks to relieve itching.
If you're having trouble with dizziness, drink plenty of fluids and rise slowly after lying or sitting down. When you feel dizzy, lie on your left side to restore your blood pressure.
As long as your pregnancy is proceeding normally and you are comfortable, you can have sex as often as you like unless your doctor has advised strict abstinence.
Ideal Weight gain
If your pre-pregnancy weight was in the healthy range for your height (a BMI of 18.5 to 24.9), you should gain between 10 and 15 Kg, gaining 0.5 kg in the first trimester and about 0.5 kg per week for the rest of your pregnancy for the optimal growth of your baby.
If you were underweight for your height at conception (a BMI below 18.5), you should gain 12- 18 Kg.
If you were overweight for your height (a BMI of 25 to 29.9), you should gain 8-10 Kg. If you were obese (a BMI of 30 or higher), you should gain between 5-8 Kg.
If you're having twins, you should gain 18-25 Kg if you started at a healthy weight, 15-20 Kg pounds if you were overweight, and 10-15 Kg pounds if you were obese.12
Weight Management and Exercise
Gaining weight is important but gaining excess or less weight is not healthy. So never go on a diet or try to lose weight during pregnancy. Moderate exercise can help burn extra calories.
The more active and fit you are during pregnancy, the easier it will be for you to adapt to your changing shape and weight gain.
Smoking and Tobacco
Smoking and second hand smoking are significant factors in miscarriages during the first trimester and also contribute to a number of other threats to the health and development of the foetus. Hence it is advised to quit smoking.
Drinking alcohol during pregnancy, can permanently damage your developing baby's cells. Heavy drinking can also damage your baby's nervous system developing foetal alcohol spectrum disorders (FASD), with problems that can range from mild learning difficulties or social problems, through to birth defects.
Hence avoid alcohol during pregnancy.
Relaxation techniques like yoga, meditation and breathing exercises help reduce the stress during pregnancy.
Reduce the intake of tea, coffee, colas and chocolate especially later in the day. Lowered caffeine intake is known to induce a better sleep during the night.
Never take over the counter, herbal or any other medications without consulting your doctor.
Avoid fried foods, carbonated drinks, citrus fruits or juices, and spicy foods.
Include plenty of fiber in your diet
Drink lots of fluids.
Gaining adequate weight is very important during pregnancy for your health as well as the development of your baby. So below are some of the tips for a healthy diet.
Fresh fruits and vegetables make good snacks. They are full of vitamins and low in calories and fat.
Eat breads, crackers, and cereals made with whole grains.
Choose reduced-fat dairy products. You need at least four servings of milk products every day. However, using skim, 1%, or 2% milk will greatly reduce the amount of calories and fat you eat. Also choose low-fat or fat-free cheese or yogurt.
Naturally sweetened is better than foods and drinks with added sugar or artificial sweeteners.
Food and drinks that list sugar or corn syrup as one of the first ingredients are not good choices.
Many sweetened drinks are high in calories. Read the label and watch out for drinks that are high in sugar. Substitute water for sodas and fruit drinks.
Avoid junk-food snacks, such as chips, candy, cake, cookies, and ice cream. The best way to keep from eating junk food or other unhealthy snacks is to not have these foods in your house.
Do not add salt to foods when cooking. Salt causes your body to retain water.
Go light on fats. Fats include cooking oils, margarine, butter, gravy, sauces, mayonnaise, regular salad dressings, sauces, lard, sour cream, and cream cheese. Try the lower fat versions of these foods.
Most restaurants have menus and nutrition facts on their websites. Use these to plan ahead.
In general, eat at places that offer salads, soups, and vegetables.
Avoid fast food.
Cooking at home:
Prepare meals using low-fat cooking methods.
Frying foods in oil or butter will increase the calories and fat of that meal.
Baking, broiling, grilling, or boiling is healthier, lower-fat methods of cooking.(15)