The Third Trimester
26-40 weeks
You’re getting close, hang in there!!
It is important that you feel regular movement and that you contact the office if you notice decreased fetal movement.
Movement should be becoming more regular. You should feel your baby move at least 8 times a day. Kicks may be replaced with shifting.
Your baby is dozing or sleeping up to 95 percent of the time, however your baby is usually still moving.
You will feel most movement at night or in the early morning. This has to do with your adrenaline levels and the “fight or flight” response. During the day your adrenaline levels are high and driving sugar into your cells because you are working. Then at night when you are at rest, your adrenaline levels drop and extra sugar goes into the baby, revving your baby up!
26-28WEEKS
You will start seeing us every 2 weeks until 36 weeks.
During this trimester we will be monitoring your blood pressure and watching the growth of your baby.
Screening for Gestational Diabete
As healthy as you may be, every pregnant woman should be screened for gestational diabetes.
Why?
During pregnancy, your placenta produces hormones (human placental lactogen) that interferes with the function of your insulin, the hormone which helps you manage your sugar. This happens because your baby requires a continuous source of sugar and nutrients. Because your insulin is being interfered with by human placental lactogen, when you eat a meal high in simple carbohydrates it overwhelms your ability to handle the influx of sugar.
Any excess sugar that does not get stored by you will go to the baby and will make a large baby, making delivery more difficult.
This is true even if you pass your screening test.
We recommend you stay away from simple sugars:
white flower: pasta, bread, cereal
and high sugar foods:
potatoes, processed foods, sweets and high fructose corn syrup.
We recommend you follow a Mediterranean diet.
One Hour Glucose Challenge Test
Things to know before the test
- Do NOT take this test if you are currently diagnosed with Diabetes.
- Nothing to eat or drink (except for water) after midnight
- You will be given a bottle of a 50-gram oral glucose beverage the day of the test or during a prior visit.
- The beverage does not need to be refrigerated; however, it may taste better cold.
- For accurate results, it is important that you follow these instructions exactly.
On the day of your test
- Drink the entire bottle of the 50-gram glucose beverage within 5 minutes.
- Note the exact time you finish drinking the glucose solution as this is important for the accuracy of the test.
- We will draw your blood exactly 1 hour after you have finished the drink
- Do not eat or drink anything except sips of plain water after finishing the beverage (No mints, cough drops, chewing gum or smoking is allowed).
- Be sure to arrive to the office 10 to 15 minutes early to ensure you have your blood drawn at the 1-hour mark.
- Please check in at the front desk and state that you are here for the 1 Hour Glucose Test. You will be directed to the phlebotomist.
- Please notify the clinical staff if you feel ill or need assistance.
- After the test is complete, you may eat or drink as normal.
- If you have an abnormal test result, you will be called within 2 business days and may be required to follow up with a 3-hour Glucose Tolerance Test on another day.
34-36WEEKS
"Lightening."
Lightening gets its name from the feeling of lightness or relief that some women experience when the fetus moves from the rib cage to the pelvic area. It allows some women to breathe more easily and more deeply and may provide relief from heartburn.
36-40WEEKS
We will start to check your cervix through a pelvic exam to see if your cervix is starting to prepare for labor.
Group B Beta Strep Testing (GBBS)
- This test is performed at 36 weeks with your first pelvic exam. This test identifies the presence of Group B Beta Strep in the birth canal.
We normally carry bacteria as part of our GI system call normal flora. Up to 40% of the general population can carry this form of Strep as part of their normal flora and this poses no harm unless you are pregnant. If you are pregnant and are colonized with GBBS, you will be treated with antibiotics in labor as away of giving your baby antibiotics.
LABOR
Braxton Kicks, False Labor, Labor
Learn More about…
..common Symptoms in the Third Trimester
VAGINAL BLEEDING
Vaginal Bleeding is never normal to have during your pregnancy.
During pregnancy there is increased blood flow to the cervix which can bleed following:
- Intercourse
- Pelvic exam
- Transvaginal Ultrasound
While it is not uncommon to have some spotting following intercourse, the vaginal bleeding may be coming from the placenta and could be a sign of a more serious condition. It’s always better to discuss any spotting or bleeding with your doctor to make sure that there is no cause for alarm.
If you experience any vaginal bleeding, please contact our providers at the office as soon as possible.
PELVIC PAIN: Pelvic Floor Pressure and vaginal pain
"Lightening."
Lightening gets its name from the feeling of lightness or relief that some women experience when the fetus moves from the rib cage to the pelvic area. It allows some women to breathe more easily and more deeply and may provide relief from heartburn.
This may happen several weeks or only a few hours before labor begins. Not all fetuses drop before birth.
With the addition pressure on the pelvic floor, some women will experience a spasm of the vagina which may be perceived as a shock within the vagina. Getting off your feet may help eliminate some of the pain.
FREQUENT URINATION
You will find that frequent urination will pick back up or continue throughout your pregnancy as the expanding baby and uterus place pressure on your bladder. As a result, you’ll need to urinate more often.
Near the end of the third trimester, when your baby is preparing for childbirth, his or her head drops into the pelvis and presses squarely on your bladder — which means you’ll have that “gotta-go” urge more than ever.
For nighttime urination, those swollen feet and ankles can also play a part. When your body absorbs the fluid in your legs while you’re sleeping, those fluids are used to make urine.
Try to empty your bladder completely by leaning forward as you urinate, so that you’ll hopefully need fewer trips to the toilet.
Also, don’t cut back on liquids thinking it’ll keep you out of the bathroom. Your body and your baby need a steady supply of fluids during your pregnancy.
EDEMA AND SWELLING
Swelling in your hands, fingers, feet, and ankles is another common symptom of pregnancy.
Various factors contribute to foot and ankle swelling during pregnancy. For starters, your body retains more fluid during pregnancy. Also, your growing uterus puts pressure on your veins, which impairs the return of blood to your heart. Hormonal changes also play a role.
Foot and ankle swelling during pregnancy is common and usually goes away after delivery.
What can you do to help the swelling?
- Stay off your feet. Avoid standing for long periods. When you can, sit with your feet up and occasionally rotate your feet at the ankles and gently flex your feet to stretch your calf muscles. Better yet, lie down with your legs elevated.
- Sleep on your left side. This takes pressure off the large vein that returns blood from the lower half of your body to your heart (inferior vena cava). It also might help if you elevate your legs slightly with pillows.
- Wear compression stockings. Your health care provider might recommend wearing supportive tights or stockings during the day.
- Be physically active every day. Take walks, ride a stationary bike or swim laps in a pool.
- Stand or walk in the pool. Although there’s little research on the use of water pressure for foot and ankle swelling, standing or walking in a pool seems to help compress tissues in the legs and might provide temporary relief from swelling during pregnancy.
- Wear loose clothing. Tight clothing can restrict blood flow. Don’t wear socks or stockings with tight bands on the ankles or calves
HEADACHES
Headaches during pregnancy may also be caused by an increase in blood flow. There is an approximately 50% increase in the volume of blood flowing while you are expecting.
- Tylenol, extra strength – It is recommended that you do not take more than 4000 mg of acetaminophen a day.
AVOID
- All NSAIDs: Ibuprofen, Motrin, anaprox, Aleve should NOT be taken during pregnancy as they can adversely affect your baby’s circulation and amniotic fluid.
Sinus Headaches
Because you’re moving more air, your sinuses may be over worked, and inflammation can lead to sinus headaches. If you think it may by sinus related headache, try an antihistamine. Be careful of using a decongestant as this may aggravate your blood pressure.
Headache in the presence of elevated blood pressure and visual changes may be signaling the development of pregnancy induced hypertension and should be reported to your doctor.
SHORTNESS OF BREATH
The state of pregnancy increases a woman’s demand for oxygen. To meet this demand, pregnant women hyperventilate, not by breathing more rapidly but by breathing more deeply. As your pregnancy progresses the growing uterus impinges on the chest cavity causing the total lung volume decreases, which decreases reserve lung capacity. This will often produce the normal symptoms of shortness of breath during minimal exertion.
However, if this symptom becomes persistent, please contact me or one of my partners.
SKIN CHANGES
Strech Marks
You might notice uneven streaks of pink, red, or purple developing along your body as it expands. Your thighs, bottom, breasts, and abdomen are the most common places. Using a heavy moisturizer may help keep your skin soft, but it will not help get rid of stretch marks. Most stretch marks fade after the baby is born, but they may never disappear completely.
Melasma
Due to the hormones in pregnancy, your skin may develop darker patches of pigmentation on the face, shoulders, forearms, or the line running down from your navel. Some women’s nipples, genitals, and freckles become darker or more pronounced. Dark spots and melasma usually fade on their own after you give birth. Some women, however, may have dark patches that last for years.
ITCHY SKIN
Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)
In pruritic urticarial papules and plaques of pregnancy (PUPPP) – small, red bumps and hives appear on the skin later in pregnancy. Your skin might become itchy where it’s stretching. The bumps can form large patches that can be very itchy. These bumps usually first appear on the abdomen and can spread to the thighs, buttocks, and breasts.
It is not clear what causes PUPPP. It usually goes away after you give birth.
What can you do to relieve the itching?
- Take cool baths or showers to soothe your skin and use fragrance-free body wash. A soothing oatmeal cleanser is a good option. You can also add colloidal oatmeal to a bath and soak for 10 to 15 minutes, which helps with itching.
- After your shower, moisturize your skin with a fragrance-free lotion or ointment for itchy skin.
- Petroleum jelly can also help relieve very itchy skin and might work better than a cream. Then, wear loose-fitting, cotton clothes.
- If your rash only affects a small area, you can apply a hydrocortisone anti-itch cream to the area.
- You can take newer antihistamine allergy medication, like cetirizine or cyproheptadine.
Cholestasis of Pregnancy (ICP)
Itchy Hands and Feet
Itching on you’re the soles of your feet and palms of your hands might indicate another medical condition called cholestasis Intrahepatic Cholestasis of Pregnancy (ICP). The main symptom of condition is severe itching in the absence of a rash. Itching commonly occurs on the palms of the hands and soles of the feet, but it also can spread to the trunk of the body. Symptoms usually start during the third trimester of pregnancy but often go away a few days after childbirth.
Tell your provider if you have any of these symptoms. ICP may increase the risk of preterm birth and other problems, including, in rare cases, fetal death.
HEARTBURN
As previously mentioned, Progesterone levels are very high during pregnancy. Progesterone relaxes smooth muscle like your uterus.
Unfortunately, the GI tract from halfway down your esophagus to the anus is all smooth muscles. High levels of circulating progesterone slow the motility of the gastrointestinal tract. As a result, there is delayed emptying of the stomach, which increases the risk of heartburn.
Antacids taken regularly, as needed, with every meal, or at bedtime:
- Antacids
- Rolaids
- Tums
- Maalox
- Mylanta
- H2 receptor agonists and proton pump inhibitors
- Prilosec
- Pepcid
- Zantac,
- Prevacid