Third trimester: Special circumstances

High blood pressure during pregnancy

At each office visit, your health care provider will check your weight and blood pressure. This is done to check for signs of high blood pressure (known as pregnancy-induced hypertension) and the complication of preeclampsia.

Important

Call your health care provider if you have any of these warning signs:

sudden weight gain (more than two pounds in one day or five pounds in one week)
sharp or severe pain in your abdomen
headache
blurred vision
sudden swelling in your hands and face
noticeable change in your baby's activity
vaginal discharge that is watery, bloody or has a bad odor
sudden vaginal bleeding
slow leak, steady trickle, or sudden gush of amniotic fluid from the vagina
a temperature of more than 100.4 degrees Fahrenheit.

Pregnancy-induced hypertension

High blood pressure can cause problems for both you and your baby. When you have high blood pressure, your baby doesn't get enough oxygen and nutrients. That can lead to your baby not growing well and being born too small. In addition, high blood pressure can damage your blood vessels and organs.m

Preeclampsia

Preeclampsia is a condition in which you have high blood pressure, protein in your urine and swelling (edema). Although preeclampsia can be mild, it can quickly become more serious. Untreated preeclampsia can lead to seizures (eclampsia); damage your blood vessels, nervous system and organs; and even cause death.

Untreated preeclampsia also puts your baby at risk for problems with the placenta and can cause death.

Blood tests are needed for your health care provider to make a diagnosis.

Call your health care provider if you have any of these signs:

a sudden weight gain of more than one pound a day (two pounds in one day or five pounds in one week)
swelling (edema) of your hands and face
decreased amount of urine that is also dark
severe or constant headache unrelieved by acetaminophen (Tylenol�)
blurred vision
pain in upper-right abdomen, a dull achy feeling under your ribs or in your stomach area, and/or flu-like symptoms
a jittery feeling.

Treatment for preeclampsia depends on whether it is mild or severe.

In general, if you have mild preeclampsia, you will have more visits with your health care provider and more tests to check on your baby's health. These tests include ultrasounds and fetal movement counts. You may also be put on bedrest (see below). It is important to follow your health care provider's advice about resting.

If the preeclampsia becomes severe, you may need to have home nursing services or stay in the hospital. The decision of when and how to deliver your baby epends on the risks to you and the health of your baby.

Rh Negative

Red blood cells can contain a protein called Rh factor. Most people have this protein and are known as Rh positive. People who do not have Rh factor are known as Rh negative. A blood test can tell if you are Rh positive or Rh negative.

Problems can develop during pregnancy if you are Rh negative and your baby is Rh positive. During pregnancy you and your baby do not share blood. However, your baby's blood cells can cross the placenta into your blood.

Your Rh negative blood then reacts to your baby's Rh positive blood by making antibodies against your baby's blood. These antibodies can affect your baby by causing:

anemia
jaundice
illness
brain damage
death.

A blood test can tell if your body has made these antibodies against your baby's blood. If there are no antibodies, you can take a medicine (RhoGAM�) to prevent your blood from reacting against your baby's blood. RhoGAM is given as an injection (shot) in your arm. You may receive RhoGAM at 28 to 32 weeks of pregnancy and/or within 72 hours of giving birth to an Rh positive baby.

Bedrest

If you have a health complication or high-risk pregnancy, you may be put on bedrest.

This can mean:

Important

Call your health care provider right away if you have signs of preterm labor before 37 weeks of pregnancy:

change or increase in vaginal discharge
bleeding from your vagina
slow leak, steady trickle, or sudden gush of amniotic fluid from your vagina
n a regular pattern of six or more uterine contractions in one hour
menstrual-like cramps for more than one hour
increased pelvic pressure for more than one hour
intestinal cramping, with or without diarrhea or indigestion, for more than one hour
throbbing in the vagina, cramps in the thighs, or a feeling that your baby is pushing down
a feeling that things are not right.

working less and spending at least half of each day with your feet up
being in bed, lying down or sitting up
lying in bed or on the sofa, getting up only to go to the bathroom.

Ask your health care provider to be specific about the kind of bedrest you need and what you can and cannot do. Common reasons for bedrest include:

preterm labor
your baby is not growing fast enough (intrauterine growth restriction)
high blood pressure (that started either before or during pregnancy) or preeclampsia (high blood pressure, protein in your urine, and swelling)
carrying more than one baby (multiple gestation)
your cervix opens painlessly too early in pregnancy (also known as incompetent cervix).

Bedrest will not cure any of these conditions. However, it can help manage them.

Bedrest brings major changes to your household. You will have to rely on your husband, partner, family members, or friends to help you with shopping, meals, laundry, and getting ready for your baby.

You may feel fine, making it hard to stay in bed. This is especially true if you feel pressure to return to work or keep up with your workload.

It may help to think about bedrest as being one way to parent your baby right now. Each member of your family can take on new tasks to help your baby.

Tips to help you cope with being on bedrest:

Get dressed each day rather than staying in night clothes.
Keep toiletries, a brush, hair ties, and makeup near your bed. Using them will make you feel better.
Do relaxation and gentle stretching exercises.

Tip

If you are on bedrest and/or your pregnancy is considered high risk, your health care provider may want you to have home visits by an OB nurse.

The nurse will visit you in your home, monitor you and your baby as needed, and support you and your family during this time. Talk with your health care provider to see if home visits are right for you.

Ask your health care provider about exercises to help maintain your muscle tone.
Keep a journal.
Do whatever household tasks you can from your bed like paying bills and folding laundry.
Make lists of what needs to be done and ask friends and family members to take on these tasks.
Borrow books from the library.
Write letters, do crossword and Sudoku puzzles, start a needlework or quilting project.
If your health care provider agrees, you may be able to play with your child(ren) in bed or even conduct work meetings via phone or computer in your bedroom.
Do work, if you can, on a lap desk or computer.
Ask your friends to pay regular visits and let them run errands for you.
Talk to other moms on bedrest over the phone or on the Internet using a laptop computer.
Bedrest often means no sexual intercourse or orgasm. Hug, snuggle, watch movies together, and search for ways to feel and be close.

For bedrest support, call Sidelines National Support Network, 1-888-447-4754.

Going Past Your Due Date

Your due date is only an estimate for when your baby is likely to be born. Most babies are born between 37 and 42 weeks. It is normal to give birth to your baby one to two weeks after your due date. Your health care provider will monitor you and your baby during your office visits.

Your health care provider may:

use an electronic fetal monitor to check your baby's heartbeat
use an ultrasound to measure the amount of amniotic fluid around your baby (This will also let you see your baby's movements.)
check for softening and thinning of your cervix
consider starting labor if it may reduce health risks for you or your baby.

Tips for coping with going past your due date

Get plenty of rest. It is important to get plenty of rest to build up your energy for labor. Sleep in while you can. If you are having trouble sleeping at night, take naps during the day.
Let your answering machine pick up your calls. It may be hard to keep answering the phone and telling your family and friends that you are still pregnant. Set up a phone tree for communicating your news.
Enjoy the extra time. Use the extra time to address birth announcements or write thank you notes. Finish any last minute details in the nursery. Take some time to pamper yourself.
Keep making plans. You may want you to stay close to home. However, you can still make plans to see a movie or go out for dinner.
Be cautious about home remedies. You have probably heard of home remedies that may help start labor. These may cause more harm than good. Talk with your health care provider before trying them or alternative treatments.
Keep in contact with your health care provider. You will need to have frequent checkups until your baby is born. Continue to monitor your baby's movements using the fetal movement count worksheet. Call your health care provider any time you are worried about yourself or your baby's well-being.