Third Trimester: Preparing for Delivery and Complication Surveillance
In the third trimester (28 weeks until delivery), the focus shifts to delivery planning and monitoring for potential maternal or fetal complications.
History Elements to Prioritize
Antenatal Visits: Ongoing assessment of booking and care continuity.
Fetal Movement Monitoring: Patient should report perception of fetal movements
• Reduced or absent movements may indicate fetal distress.
Bleeding Per Vaginum:
Causes include
• Physiological show with labor onset,
• Placenta previa,
• Abruption placentae,
• Scar rupture (common in previous cesarean sections), and
• Cervical lesions.
Prompt history helps distinguish between these and initiate appropriate referral.
Drug Compliance: Continued iron and calcium supplementation adherence should be emphasized.
Symptoms of Preeclampsia or Eclampsia:
• Persistent headache,
• Visual changes,
• Abdominal pain,
• Swelling, and
• Decreased urine output
If present, require urgent attention.
Pain Abdomen: Causes in late pregnancy include
• Labor Pain,
• Abruption,
• Uterine Rupture (Scarred Uterus), But Also
Non-Obstetric Causes Like
• Urinary Tract Infections Or
• Appendicitis Etc.
Leaking Per Vaginum: Assess for rupture of membranes (ROM)—
• Premature rupture of membranes (PROM) if term,
• Preterm premature rupture of membranes (PPROM) if before 37 weeks.
Diagnosis includes history, clinical exam with speculum, and tests for leakage of amniotic fluid.
Birth preparedness and Complication Readiness (BPCR) — preferred place and mode of delivery, plans for labor and other components of BPCR
Psychosocial aspects — support system, stress, mental health, and counseling needs
Signs of labor or complications — premature rupture of membranes, contractions, bleeding.
References:
• Dutta DC. Textbook of Obstetrics. 9th ed. Jaypee Brothers; 2023.
• Padubidri VG, Daftary SN. Shaw’s Textbook of Gynaecology. 18th ed. Elsevier; 2022.
• Park K. Park’s Textbook of Preventive and Social Medicine. 28th ed. Bhanot; 2025.
• Babu SA. Clinical Obstetrics and Gynecology. 2nd ed. Wolters Kluwer; 2025.
• Care During Pregnancy and Childbirth: Training Manual for Community Health Officers. Ministry of Health and Family Welfare, Government of India; 2019. Available from: https://nhsrcindia.org/sites/default/files/2021-12/Care%20During%20Pregn... (Accessed 2025 Nov 17).
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