ANTENATAL CARE – THIRD TRIMESTER

• Third trimester – 29 to 40 weeks

Schedule for Antenatal Visits 

• up to 28th week – Monthly 
• From 28th week – 36th week – Every two weeks
• From 36th week until birth – Every week

• Physiological and Hormonal changes associated with pregnancy

Symptoms

• Amenorrhoea continues
• Enlargement of Abdomen - Time of accelerated foetal growth causes some mechanical discomfort like palpitation or dyspnoea following exertion
• Increased frequency of micturition due to the pressure of the descending foetal head on the bladder
• Active foetal movements continue to be perceived
• Lightening – 38th week; a sense of relief of the pressure symptoms due to the engagement of the presenting part

Signs

• Cutaneous changes are more prominent with increased pigmentation and striae
• Uterine shape – from cylindrical to spherical beyond 36 weeks
• Symphysio fundal height – At 32 weeks –the junction between the upper and middle third of the distance between the umbilicus and ensiform cartilage; 36 weeks –at the level of ensiform cartilage, 40 weeks –at the level of 32 weeks because of the engagement of the presenting part
• After 24 weeks, the SFH in cm corresponds to the number of weeks up to 36 weeks
• Braxton – Hicks Contraction more evident
• Foetal movements – easily felt
• Palpation of the foetal parts and their identification become much easier
• Foetal heart sounds – heard distinctly

• Hb, PCV
• Urine routine – every visit
• TSH

Ultrasound

• Used for assessing foetal growth and well – being, foetal biometry, foetal environment, viability, placental location, subjective liquor assessment, Doppler velocimetry, confirmation of presentation, for diagnosing IUGR, Suspected intrauterine foetal demise, etc
• The single most important predictor of small for gestational age (SGA) and IUGR is an abdominal circumference below the 10th percentile

Supplementation

• Same as second trimester

Ayurvedic Management

• Can continue the medicines of the second trimester
• Seventh month – especially Madhuraoushada siddha ksheerasarpi, Prithakparnyadi siddha Gritha
• Eighth month – ksheerayavagu with sarpi
• Ninth month –yavagu with bahusneha, snigdha mamsarasodana

For Easy delivery without any complications

• If the pelvis is adequate & if there is no CPD, then Shodhana vasti with Dashamoola kashaya and Bala taila ( after eight months is completed). Usually done with enema can without adding saindhava, madhu and kalka. Should not try to do shodhana vasti without expertise
• Matravasti can also be done on alternate days. Matravasti with Balataila can be done
• Yoni pichu - Balataila ( after eight months) 
• Abhyanga - Balataila (from the ninth month) 
• Bath – Vataghna patrasiddha jala
• Internally - Sukumara gritha or Sukhaprasava gritha after eight months