An ultrasound in third trimester could show many clinical indicators of fetal well-being. First it shows us the fetal number-which most likely is already known. It also shows us the baby’s presentation. “If breech, describe the “type” of breech” Frank, Complete, Incomplete, Footling” (TOP, 2017). This ultrasound will also tell us the fetal biometry and estimated fetal weight, Amniotic Fluid Volume, Placentation, Fetal movements, and Consider re-visualizing select fetal anatomic structures when a third trimester assessment is being performed (TOP, 2017). Its also important to check the babies heart tones and the mother’s vital signs, particularly the blood pressure. Always ask if the mother is having any bleeding, leaking, constant contractions and is she feeling the baby move well. It is also important to check the mother’s urine.
Steps to take if findings are not reassuring during third trimester depend on the finding. If the baby is breech. External cephalic version is one way to turn a baby from breech position to head down position while it’s still in the uterus. It involves the doctor applying pressure to your stomach to turn the baby from the outside(Healthline, 2018). For high blood pressure and signs of preeclampsia, “You may have to stay at the hospital for observation and to manage your blood pressure until the baby is old enough for delivery. If your baby is younger than 34 weeks, you will probably be given medication to speed up the baby’s lung development”(Healthline, 2018). For most findings that are not reassuring the patient will be sent to the hospital for monitoring for mother and baby.
Healthline. (2018). What Might Go Wrong in the Third Trimester?. Retrieved on February 23, 2019 from https://www.healthline.com/health/pregnancy/third-trimester-complications#post–term
Toward Optimized Practice (TOP). (2017). THIRD TRIMESTER FETAL WELL-BEING STUDIES: CRITERIA AND MANAGING RESULTS. Retrieved on February 23, 2019 from http://www.topalbertadoctors.org/download/2129/Third%20Trimester%20Fetal%20Well-Being%20Studies.pdf?_20180914050143
Question 1—Third Trimester
Fetal growth is an important part of fetal assessment in the third trimester. Studies show that poor fetal growth in the second and third trimesters are associated with increased risks of preterm birth, low birthweight, and long-term adverse health outcomes (Gaillard, Steegers, de Jongste, Hofman, & Jaddoe, 2014). Fundal height is often used to assess fetal growth. If fundal height differs by 3 cm or more from gestational age, a follow-up ultrasound is advised to assess further (McCowan, Figueras, & Anderson, 2018).
Fetal heart rate and fetal activity should also be routinely assessed. The mother should be asked about fetal activity. Counting the kicks should be highly encouraged starting at week 28 (Bryant & Thistle, 2019). A kick count of less than 10 in 2 hours may be cause for concern (Bryant & Thistle, 2019). Fetal heart rate should also be assessed at every prenatal visit in the third trimester (ACOG, 2018). A typical fetal heart rate is between 120 and 160 beats per minute. Changes in fetal activity or fetal heart rate indicate a need for further testing. A non-stress test and/or a biophysical profile (BPP) may be ordered when results are nonreassuring (ACOG, 2018). A biophysical profile is an ultrasound that assesses: fetal breathing movement, fetal movement of the body or limbs, fetal tone and amniotic fluid volume (Bryant & Thistle, 2019).
Maternal blood pressure, urinalysis, and degree of edema are also important measurements that can affect the health of the fetus (Zolotor & Carlough, 2014). Blood pressure measurements can help identify chronic hypertension or hypertensive disorders that develop during pregnancy, such as preeclampsia or gestational hypertension (Zolotor & Carlough, 2014). Edema may be a normal finding but can also be a sign of preeclampsia (Zolotor & Carlough, 2014). Protein in the urine may also indicate preeclampsia risk (Zolotor & Carlough, 2014). These findings may also suggest the need for blood tests, fetal ultrasounds, nonstress tests, or a BPP (Zolotor & Carlough, 2014).
Lastly, fetal presentation is encouraged to be assessed beginning at 36 weeks gestation (Zolotor & Carlough, 2014). This is most often done using the Leopold maneuvers (Zolotor & Carlough, 2014). External cephalic version may be used to turn a fetus from a breech or transverse position into a vertex position before birth (Zolotor & Carlough, 2014).
ACOG. (2018). Special tests for monitoring fetal health. Retrieved from https://www.acog.org/Patients/FAQs/Special-Tests-for-Monitoring-Fetal-Health?IsMobileSet=false#exam
Bryant, J. & Thistle, J. (2019). Fetal movement. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470566/
Gaillard, R., Steegers, E. A., de Jongste, J. C., Hofman, A., & Jaddoe, V. W. (2014). Tracking of fetal growth characteristics during different trimesters and the risks of adverse birth outcomes. International Journal of Epidemiology, 43(4), 1140-1153. https://dx.doi.org/10.1093%2Fije%2Fdyu036
McCown, L., Figueras, F., & Anderson, N. (2018). Evidence-based national guidelines for the management of suspected fetal growth restriction: Comparison, consensus, and controversy. American Journal of Obstetrics & Gynecology, 218(2),855-868. doi: 10.1016/j.ajog.2017.12.004.
Zolotor, A., & Carlough, M. (2014). Update on prenatal care. American Family Physician, 89(3), 199-208. Retrieved from https://www.aafp.org/afp/2014/0201/p199.html
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