2546- Third Trimester
When does the third trimester occur?
28 weeks - delivery/ term
Vernix casoesa
The white thick coating that serves as extra protective coating from fluid
The longer the fetus remains the less of the caseosa
Crown-to-rump measurment
28: 27, 1100g
30-31: 31cm, 1800-2100
36: 35, 2200-2900
40: 40, 3200+
Fetal development: Musculoskeletal
Bone ossification
head movement
Fetal Development: nervous system
sleep-wake cycle
cries
stong such reflex
Fetal Development: Respiratory
Lung maturity
2:1 ratio
Fetal Development: sensory organ
sense of taste
aware of sounds
reacts to light
Fetal Development: Genital
Testes in scrotum and vagina development
not always descended until birth
Maternal Development: Lightening
Drop in the fundal height
less pressure on the diaphragm and more pressure on the bladder
Colostrum is produced by prolactin
Maternal Development: Cardio and respiratory
SBP decreases and DBP increases until the term
Chest breathing is more than abdominal breathing
Maternal Development: Musculoskeletal
Waddling gait
Rectus abdominal separation may occur
protrusion or flattening of the umbilical
Maternal Development: Gastrointestinal
Acid reflux
maternal gut microbe: beneficial for the baby
Maternal Development: neurological
Carpel tunnel caused by peripheral edema
Common Discomforts
Insomnia
dyspnea
Ankle edema
Psychosocial
Routine Prenatal care
Visits every 2 weeks
after 35 weeks a weekly visit
Care for after 40 weeks
Induction 41- 42+
Kick counts
Sit down
feet up
6 kicks in 2 hours
High Risk: HPD
Non- Severe: 140/90, 2 separate measurements- 15 mins apart
Severe: 160/110, 2 separate measurements- 15 mins apart
High Risk: Chronic HPD
Pre-existing or before 20 weeks
A) Comorbid
type 1 or type 2
B) Super imposed
Resistant hypertension
Proteinuria
Adverse comp
High Risk: GHPD
Occurs for the first time beyond 20 weeks
Pre-eclampsia
High Risk: GHPD management
BP consistently
Tendon reflexed
NST, BPP, US
activity and diet
Labetalol HCL
High Risk: Pre-eclampisa
HPD with proteinuria
Reduced organ perfusion
PROTEINURIA: 0.03g/L in 2 random urine- 6 hrs apart
0.3g/l in 24 hrs
High Risk: Pre-eclampsia complications
Headaches, GCS <13
O2<50
Increase in creatine
Abnormal FHR
Hematoma
N&V
High risk: Eclampsia
Strokes before, during or after birth
Pre-eclamp & Eclamp Etiology
Thick, rigid placenta
leading to cell activation that leads to decrease in organ perfusion
HELLP syndrome
hemolysis, elevated liver enzyme, low platelets
HPD and Proteinuria may not be present
S&S: Malais, N&V, Epigastric RUQ pain
HELLP Pathophysiology
Endothelial cell dysfunction that leads to RBC hemolysis and narrowing of BV
Hyperbilirubinemia causes necrosis and increase of liver enzymes
HELLP Management
Monitor urine output
Monitor FHR and look for Hypoxia
Placental deattachment
HELPP Pharmacological measurements
1) Corticosteroids
Buys time for lung maturity
Admin: 12mg IM X2- 24 hrs apart
2) Mg(SO4)
CNS depressant- seizure
IV 4g loading- 1-2 maintenance: 24 hrs
3) Calcium gluconate
Mg Toxicity
GDM BG control
Fasting: 3.8-5.2
1hr PP: 5.5-7.7
2hr PP: 5.0-6.0
High Risk: Placenta Previa
Placenta Implants in lower segments either fully or partially cover the uterus
S&S: Bright red and painless bleeding
VS and FHR may be normal
Increase in fundal height and non- tender uterus
Expectant VS Active Placenta Previa
EXCPECTANT: Pt < 36 weeks
monitor bleeding and decrease activity
ACTIVE: Pt> 36 weeks
Prep fo surgery
High Risk: Placental Abruption
Detattachment of placentas from the implantation site
S&S: Rigid Abdomen
Vaginal Bleeding
Placental Abruption Management
Rh Immunoglobin
large Bore IV
Indwelling folley
blood on standby
High Risk: Premature Dilation of Cervix & management
dilation in the second trimester
Management: Cervical cerclage
no sexual intercourse
High Risk: PROM & PPROM
weakening of amniotic membrane
gush or leak of odourless liquid
High Risk: Preterm Labour & birth
20-36.6 wks of regular uterine activity
Diagnosis: Tocolytics
Antibiotics
High Risk: Poly/ oligohydramnios
Poly: excess AFV, > 2L
olio: Too little AFV, < 300ml
High Risk: Amniotic Fluid Embolisim
Sudden Cardiac hypotension and hypoxia collapse
Foreign substances entered maternal circulation
Occurs during labour, birth, or after delivery
Intervention: Oxygenate, CPR
High Risk: IUGR
Symetrical: Chronic, genetic, and chromosomal abnormalities
Asymmetrical: Weight associated, deprivation, undernutrition
High Risk: Multiple Gestation
Dizygotic: faternal
Monozyogtic: identical