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.

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. This 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.

Preeclampsia

Preeclampsia is a condition in which you have high blood pressure, protein in your urine, and swelling (edema). Preeclampsia 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.

In general, if you have 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 reduced activity. It is important to follow your health care provider's advice about resting.

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

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

• sudden weight gain (more than two pounds in one day or five pounds in one week)
• sharp or severe pain in your abdomen
• 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 higher than 100.4 F
• decreased amount of urine that is also dark
• severe or constant headache not relieved by acetaminophen (Tylenol^®)
• pain in upper-right abdomen, a dull achy feeling under your ribs or in your stomach area, flu-like symptoms or both
• a jittery feeling

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, but your baby's blood cells can cross the placenta into your blood. Your Rh negative blood 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

Important!

Reduced activity

If you have a health complication or high-risk pregnancy, your health care provider may suggest you reduce your activity. This is sometimes called bedrest, even though it doesn't mean just "lying in bed."

This can mean working less and spending at least half of each day with your feet up; being in bed, lying down or sitting up; or 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 reduced activity you need and what you can and cannot do. Common reasons for reduced activity include:

• preterm labor
• your baby is not growing fast enough
• high blood pressure or preeclampsia
• carrying more than one baby
• your cervix opens painlessly too early in pregnancy (also known as incompetent cervix)

Reduced activity will not cure any of these conditions but it can help manage them.

Reduced activity can bring major changes to your household. You will have to rely on your 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 not be active. It may help to think about reduced activity 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 reduced activity:

• 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.
• 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 math puzzles, start a needlework or quilting project.
• 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 pregnant people on reduced activity over the phone or on the Internet using a laptop computer.
• Reduced activity often means no sexual intercourse or orgasm. Hug, snuggle, watch movies together, and search for ways to feel and be close.

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
• a sudden gush or leak of fluid from your vagina
• a regular pattern of six or more contractions in one hour
• menstrual-like cramps for more than one hour
• tightening of the abdomen
• 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 feeling your baby is pushing down
• a feeling that things are not right

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 week or longer 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 family, friends and co-workers know how you will announce your baby's arrival: social media, text, email, phone messages.
• 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 counts worksheet.

Call your health care provider any time you are worried about yourself or your baby's well-being.