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Third Trimester

Prenatal visits:

You will continue to have visits every 2 weeks.  We will monitor your blood pressure, weight and require a urine sample at each visit.

Common concerns in the 3rd trimester:

Sleep disturbances

As you progress in pregnancy, it gets harder to sleep at night.  You should sleep on your side, and not flat on your back.  Try to avoid caffeine late in the day.  Exercise in the early evening may also help you sleep more deeply.  Try to avoid vigorous exercise within four hours of sleeping.  Relaxation techniques such as yoga, massage and deep breathing can also promote healthy sleeping habits.   Use extra pillows to obtain a comfortable position, and consider the use of a fan if you get too hot.  If you wake up in the middle of the night, and find that you can't fall back to sleep after 30 minutes, get up and drink a glass of warm milk or eat some crackers.  Then go back to bed.  If you find that this is still not helping please let us know at your next prenatal visit and we will discuss this further.

Heartburn 

It is not uncommon to experience heartburn later in pregnancy.  Recommendations are similar to those during the first trimester.  First, conservative measures such as modifying your diet and eating small, frequent meals (4-6 meals per day) is usually the most effective way to treat heartburn.  Avoid caffeine, chocolate, spicy foods, fatty foods, citrus foods.  Allow ample time from eating to lying down.

Antacids are often a first line treatment.  Ranitidine (Zantac - Category B) would be the preferred agent, however, we recommend you discuss this at your prenatal visit in order to ensure that this is the right option for you.

Swelling

It is common at the end of pregnancy to have swelling in your feet and ankles, especially if you have been on your feet all day.  We recommend avoiding salty foods given that these will make the swelling worse.  This swelling is not generally an indicator that any problems are developing however if you have swelling along with high blood pressure or rapid weight gain please call the office as you will need to be evaluated.
 

Complications of Pregnancy:

Gestational Diabetes

If your one hour glucose tolerance test was abnormal we will ask that you have a three hour glucose tolerance diagnostic test in order to diagnose gestational diabetes.  You will be referred to the Women's Center for diabetic teaching if this test is abnormal.  If you should develop gestational diabetes, your fetus may be at risk for being large for its gestational age.  This may even lead to a difficult delivery or need for cesarean section.  You will work with a nutritionist to help manage your blood sugars and if you are unable to manage your blood sugars with diet and exercise, you may be asked to start with medical management.  If you are unable to achieve blood sugars at goal with oral therapy, we may ask that you start insulin injections.  You will be managed along with the Maternal Fetal Medicine Doctors at the Women's Health Center at Saint Agnes Hospital.

Hypertension in pregnancy

If you develop high blood pressure in pregnancy you may similarly be managed in conjunction with our Maternal Fetal Medicine Doctors.  We will ask that you monitor your blood pressure at home and bring in your blood pressure logs for review.  Additional testing may also be done.  Gestational hypertension or high blood pressure in pregnancy or pregnancy induced hypertension typically develops during the third trimester.  Preeclampsia is also possible during this time.
  

Signs of preeclampsia:

We ask you to monitor for signs of preeclampsia which include:

-       Headache 

-       Change in vision such as blurry vision, black spots in vision, flashes in vision 

-       Inability to urinate

-       Nausea vomiting or epigastric pain 

-       Upper abdominal pain, specifically right sided 

-       Increase in swelling

-       Sudden weight gain

If any of these signs are noted we ask that you contact the office immediately.

Preterm Labor

One of the greatest risk to the baby at this point is premature delivery.  Premature delivery is more likely to occur in women with a previous history of preterm labor and women who are carrying twins.  Signs to watch for are:

-       Contractions

-       Spotting 

-       Increased watery discharge 

-       Lower back pains that come and go 

-       Painless tightening occurring four or more times in an hour

If you notice contractions before 36 weeks that seem to be occurring more frequently:  drink one or two large glasses of water, lie down on your left side, and record the time of the contractions for an hour.  Also note the length of the contractions.  If you have four or more in an hour you need to call us even if it is at night or on the weekend.  Early evaluation is critical.  

Other Considerations in the Third Trimester

Travel

We do not recommend travel beyond 32 weeks.  From 32-36 weeks car rides up to six hours are acceptable unless you have developed a complication of pregnancy.  Some HMO's may not cover your delivery cost for deliveries outside their service area.  You may want to check with your insurance provider prior to traveling to ensure that your delivery will be covered if you are outside of the normal coverage area.

Labor Plans

By the 36th week you should have an idea of your goals for labor.  At this point you should have selected your pediatrician and met with your pediatrician if this is offered.  You would have attended birthing classes and decided whether you will plan for pain medication during the process of labor.  This is a personal decision.  Remember you may have plans for your labor and this can be modified at any point in your process.  

You will also need to decide whether or not you would like to breast feed.  Many patients opt to write out a birth plan.  We recommend that if you have written out a birth plan you bring this plan in to discuss with your providers at your prenatal visits.