Monday 9 December 2013

Antenatal care of pregnancy without high risk factors - Third trimester

Third trimester is from 25 weeks to 40 weeks.
The frequency of visits to be increased.
Monthly visits till 28 weeks, once in 15 days till 32 weeks, weekly visits afterwards.
 Careful watch to be kept for development of any signs of hypertension, diabetes, polyhydromnios or oligohydromnios etc.
While doing the abdominal examination the size of the uterus, position of the fetus, the presenting part, the amount of the liquor to be noted fetal heart sounds to be auscultated.
Ultrasound examination to be done as part of follow-up of the growth of the fetus and to confirm the clinical findings.
The patient should continue to take iron and folic acid prophylaxis, calcium tablets.
She should take diet adequate to met the needs of the fetus.
Routine investigations like urine microscopy and hemoglobin to be repeated.
In case of high risk  cases blood sugar, urea, serum creatinine to be done.
The weight gain in pregnancy will be normally 9 to 11 kg, it will be distributed as 1 kg in first trimester, 5 kgs in second trimester and 5 kgs in third trimester.
More than half kg in one week or more than 2kgs in month is indication of chances of developing disorders like hypertension or diabetes etc.
The preconceptional weight will decide how much a woman can gain during her pregnancy.
In the obese women with BMI more than 30, weight gain better to be restricted to 6 to 7 kgs.
In third trimester better to avoid traveling and coitus as they may provoke development of premature labor.
In 38 weeks the pelvic assessment of the woman to be done to plan for the mode of delivery.
But these estimations may change once labor starts.
The woman should be instructed to come to hospital in case of pain abdomen, bleeding per vaginum or leaking per vaginum.
If do not develop any of these she can come one week prior to expected date of delivery if everything is normal she can be advised to join at the time of expected date of delivery.
In between these time she has to  do daily fetal movement count and fetal biophysical profile should be done.
In case of prior caesarean section she has to join 1 to 2 weeks before expected date of delivery so that in that time preparations for caesarean section can be done like arranging blood, taking pre anesthetic check-up etc.
These are all the steps to be taken in antenatal care of a normal pregnancy without high risk factors.

First trimester
Second trimester

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