Congratulations, you are in the final third of your pregnancy.  Hopefully you passed your diabetes screen. If you did not, you are “enjoying” your new low carb diet or possibly new medications.

If this is your first kiddo you probably have a baby shower in the works. (I was amazed with how NICE everyone was with our first baby.  We got so many wonderful and useful things. I remember getting a little choked up seeing all the stuff we received.)

For most of you, visits will continue in two week intervals until the 36th week, then you will be seen weekly until delivery.

I previously wrote about first trimester emergencies and second trimester emergencies. This blog is going to focus on third trimester emergencies and WILL NOT include regular labor precautions.  I have decided to write a separate blog about that so stay tuned!

Bleeding:

We want to hear from you before the point of hemorrhaging when you are in the third trimester. (Sorry to state the obvious!) If are having bright red bleeding (with the exceptions in this paragraph) we need to know.

There are some exceptions that are not necessarily an emergency. If you had recent sexual intercourse then having some bleeding after would be more common.  The cervix is brutally sensitive the later you get in the pregnancy, and it can bleed with even a light touch. If you are seeing red blood and you recently had sex, everything is likely OK. If it is very heavy then call us.

Another exception would be if it is associated with your mucous plug and you are at or close to term. For example, if you are 36 and ½ weeks and have some blood-tinged mucus come out, that can probably be addressed the next time we are open. If you are in the 29 week then that would warrant an emergency line call.

Lastly, if you are working through early labor at home, you will almost always have some red blood when you wipe.

Pain:

The third trimester can be super uncomfortable. I have found that it’s even more uncomfortable when you have already had a baby before.

The pelvic floor and the ligaments that keep the uterus in place have been stretched during the previous pregnancy (or pregnancies) and the brain interprets that as intense pressure. Some describe it carrying super low. Others describe shooting pains (lightening) down their groins. This is all pretty normal. If you are having severe, intractable pain then we need to hear from you.

Lastly, labor pains would warrant a call. If you are term you should wait to call until having very intense regular contraction pains lasting over a minute, each coming every 4-5 minutes for at least an hour. If you are preterm (before 37wk), you should call us if you are having painful contractions at least every 5-10 minutes that have stuck around despite resting and hydrating.

Discharge:

Pregnancy is infamous for a wonderful baseline discharge. It is usually white and thin and gets more and more copious throughout. Almost everyone needs to wear a liner in the third trimester.

If your discharge changes significantly, especially if you are preterm and it  gets more mucousy and blood tinged, we want you to call us. If you are simply having what you think is yeast or BV (bacterial vaginosis) that can wait until the office opens.

If you have copious amounts of fluid come out, like you think your water broke, then we should hear from you regardless of gestational age.

Decreased fetal movement:

As you get into the third trimester you should have pretty regular fetal movement. Most women tell me their baby moves regularly and they are not worried.

If you are having a day when you do not feel regular movement, please do a kick count. You should feel 7-10 movements in two hours. I suggest going to a quiet room with a drink and snack and just focusing on baby. If you get the movements, great. If you do not, please call.

Fever with no known illness:

You may be sick (upper respiratory infection, the flu, etc) and this can be associated with a fever. You can take Tylenol (acetaminophen) for these cases. If you have a fever (>100.4 degrees) and have no idea why then you should call us so we can help tease out the etiology.

Severe headache:

As you get closer to your due date, there is more risk of developing high blood pressure. (This is typically why obstetrical visits get closer together as you get further along.) When it is very high, it may be associated with a headache.

Whether you have or have not had blood pressures issues during the pregnancy, if you have a headache that does not resolve with Tylenol, hydration and a snack, then you should call us. Based on your history and medical problems we can help decide if you need to be seen.

Thanks for reading and stay tuned in the near future for my labor precautions blog.

Dr. B