Resources for the Third Trimester

Pregnancy-Induced Hypertension (PIH), also called preeclampsia, is a complication of pregnancy. During PIH, you may experience one or all of the following symptoms: 

• High blood pressure
• Swelling that doesn't go away
• Protein in your urine

Most symptoms of PIH go away following delivery. Women with PIH who have regular prenatal care usually deliver healthy infants.

Am I at Risk for PIH?

The following factors can increase the risk of PIH:

• First pregnancy or first pregnancy with a new partner
• Women under the age of 20 or over the age of 35
• Being African American or Hispanic
• Other members your family have had PIH
• Medical conditions such as diabetes, long term high blood pressure, or blood or kidney disease 
• Obesity, defined as weighing more than 20 percent of a normal weight

What Are the Symptoms of PIH?

The following are common symptoms of preeclampsia:

• Severe headaches
• Rapid heartbeat
• Dizziness
• Ringing or buzzing sound in ears
• Drowsiness
• Unexplained nausea and vomiting
• Doubled or blurred vision or seeing spots or stars
• Increased swelling of the hands and feet, or swelling from the feet up to the calves. 
• Smaller, more concentrated amounts of urine
• High abdominal or epigastric pain not related to eating

You may experience one or more of these symptoms. The number of symptoms of PIH may not necessarily mean how severe it is. If you have an increase of any of these symptoms, please call your provider.

What Are the Risks of PIH to the Baby?

PIH can decrease the blood flow to the placenta, providing the baby with less oxygen and fewer nutrients. And due to decreased oxygen and nutrients to your baby, he/she may be small or low birth weight. The condition may lead to seizures, so it is important to follow your provider’s instructions to decrease the severity of PIH.

The following practices can reduce your risk of PIH:

• Lying on your side to increase blood flow to the uterus and the baby
• Avoiding heavy lifting, pushing, pulling, or active exercise may increase your blood pressure
• Maintaining a balanced diet and include fruits, vegetables, breads, cereals, rice, and proteins like meat, cheese, and beans. Do not add extra salt
• Foods to avoid include lunch meats, hot dogs, soda, canned food, sweets, chips, and fast food. Follow your provider’s dietary plan.
• Decreasing the stress levels to lower blood pressure
• Taking any medications your provider prescribed as directed

Group B streptococcus (Group B strep) is a common bacterium that is usually harmless in healthy adults but can cause pneumonia or a blood infection in newborn babies.

Learn more about Group B strep from the Journal of Midwifery and Women’s Health (Wiley.com)

Glucose is a sugar that your body makes from the food you eat. Normally, glucose is converted to energy by a hormone called insulin. During pregnancy you need more energy because you and your growing baby share the same energy supply. 

Hormones made by the placenta can affect your energy level by changing your insulin balance. The amount of insulin in your body may be reduced or your baby may have a slight resistance to it. When this happens, your energy level becomes low and your glucose levels become too high. This is also known as gestational diabetes. 

The American Diabetes Association recommends that each pregnant woman has a glucose screening test between weeks 24 and 28 of pregnancy. If you are overweight when you become pregnant, have had gestational diabetes before, have a history of having large babies, or if you have other risk factors, you may be recommended to screen earlier. 

Gestational diabetes carries the following risks to the mother:

• Extreme tiredness
• Frequent vaginal and urinary infections
• Increased risk of diabetes later in life
• High blood pressure during pregnancy
• Premature labor
• Increased risk of operative delivery and poor wound/incision healing

Risks to the baby include:

• Injury at birth from growing too large
• Breathing problems because of poorly developed lungs
• Stillbirth

Day of Testing

On the day of testing, you may eat your usual well-balanced diet. This should include protein and fiber-rich foods. You should also refrain from juice, candy, or fruits prior to testing. You will be asked to drink sweetened, syrup-like liquid. One hour later, your blood sample will be taken. Your labs will usually be reported to your provider the next day.

Abnormal Results

If your test comes back high, you will be asked to do a three-hour glucose test that requires a fast for 8-10 hours. You will have a fasting blood sugar drawn, and will again drink a syrup-like drink and have your blood drawn hourly afterwards to see how your body responds to the large amount of sugar.

Results below 130 are characterized as normal, while results at or above 130 require the glucose test to determine whether you have gestational diabetes. It is possible to be intolerant to carbohydrates without being diabetic. This is usually controlled with diet and lifestyle modification.

It’s important to know the signs of early labor, or the process of your baby leaving the uterus. During labor, contractions (labor pains) push your baby down onto your cervix (the opening of your uterus).

Learn more about labor from the Journal of Midwifery and Women’s Health (Wiley.com)

It is not necessary to call the office prior to visiting the birthing center, as they will have your obstetrical history on file. If you wish to let the staff know that you are coming in, call 401-845-1110. Please use the emergency department entrance after 8:30 p.m.

Some signs it’s time to come in:

• Your “water breaks,” usually an obvious gush of warm fluid or a continuous trickle
• Any significant bleeding, such as menstrual flow. It’s not necessary to come in for pink, brown, or red spotting. Please call the office during normal business hours to report any spotting
• Contractions that are two to three minutes apart for at least an hour and strong enough so that:
  • It’s necessary to breathe through them
  • You have trouble speaking through them
  • You feel increased vaginal or rectal pressure
• Any significant headache (not relieved by Tylenol), blurred vision, or severe heartburn. These usually require a blood pressure check to rule out preeclampsia.

You may be asked to come in earlier if you have had one or more children.