Care in the Third Trimester of Pregnancy
Key Points
- Third-trimester care prioritizes early detection of maternal-fetal deterioration and labor readiness.
- Interval symptom screening, fetal movement patterns, and focused physical exam guide triage decisions.
- Late-pregnancy labs (including GBS) support intrapartum infection prevention and delivery planning.
- Patient education expands to labor signs, birth plan completion, and newborn-care preparation.
Pathophysiology
Late pregnancy increases physiologic stress on placental, cardiovascular, and metabolic systems. Risk of hypertensive disorders, preterm complications, and fetal compromise is higher, so surveillance frequency and triage sensitivity increase.
Fetal positioning and descent become clinically relevant for intrapartum planning. Third-trimester changes in maternal symptoms can indicate either normal progression or urgent pathology; interpretation requires integrated maternal-fetal assessment.
Classification
- Maternal surveillance domain: BP, edema, symptom triage, and trend review.
- Fetal surveillance domain: Movement counts, heart rate assessment, growth and position monitoring.
- Laboratory domain: CBC/H&H, STI retesting, and GBS screening window.
- Preparation domain: Labor education, feeding planning, pediatric-provider selection, and transfer readiness.
Nursing Assessment
NCLEX Focus
Any change in fetal movement pattern or severe maternal symptom cluster warrants immediate escalation.
- Obtain interval history for bleeding, fluid leakage, contractions, pain, visual change, headache, and decreased fetal movement.
- Trend BP and edema; assess for preeclampsia-spectrum cues.
- Perform fundal-height and fetal heart assessments; evaluate presentation/position when indicated.
- Review third-trimester lab results and required intrapartum prophylaxis plans.
- Confirm understanding of labor versus preterm-warning signs.
Nursing Interventions
- Teach daily fetal movement counting and escalation thresholds.
- Reinforce when to present to triage for labor, ROM, bleeding, or severe symptoms.
- Coordinate GBS-positive intrapartum antibiotic planning.
- Support childbirth preparation, feeding decisions, and postpartum/newborn transition planning.
- Arrange higher-acuity monitoring when growth or maternal signs deviate.
Fetal-Movement Delay
Delayed response to reduced fetal movement can postpone treatment for fetal compromise.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| intrapartum-antibiotic-prophylaxis | Penicillin and alternatives for GBS contexts | Given during labor, not antepartum eradication, to reduce early-onset neonatal infection. |
| antihypertensives-in-pregnancy | Labetalol and nifedipine contexts | Used for gestational hypertensive disorders with close maternal-fetal monitoring. |
Clinical Judgment Application
Clinical Scenario
At 35 weeks, a patient reports markedly reduced fetal movement and new persistent RUQ pain with elevated BP.
Recognize Cues: Maternal and fetal warning signs are both present. Analyze Cues: Pattern suggests potential hypertensive-placental compromise. Prioritize Hypotheses: Priority is urgent maternal-fetal assessment and stabilization. Generate Solutions: Initiate triage protocol, continuous monitoring, and targeted labs. Take Action: Escalate immediately to obstetric team. Evaluate Outcomes: Maternal-fetal risks are identified and managed without delay.
Related Concepts
- care-in-the-second-trimester-of-pregnancy - Midpregnancy findings influence third-trimester risk planning.
- choosing-a-birthing-place - Risk evolution may alter recommended delivery setting.
- common-discomforts-of-pregnancy - Distinguish expected discomforts from urgent pathology.
- conditions-limited-to-pregnancy - Third-trimester disorders often require rapid intervention.
- person-and-family-centered-care - Late-pregnancy counseling should include family preparedness.
Self-Check
- Which third-trimester findings most strongly predict urgent maternal-fetal risk?
- Why is GBS treatment timed intrapartum rather than earlier in pregnancy?
- How can nurses improve patient recognition of true labor and emergency signs?