Clinical assessment at third trimester visits

A. Fetal movement is documented. Vaginal bleeding or symptoms of preterm labor should be sought. Preeclampsia symptoms (blurred vision, headache, rapid weight gain, edema) are sought.

B. Fetal heart rate is documented at each visit.

C. At 26-30 weeks, repeat hemoglobin and hematocrit are obtained to determine the need for iron supplementation.

D. At 28-30 weeks, an antibody screen is obtained in Rh-negative women, and D immune globulin (RhoGAM) is administered if negative.

E. At 36 weeks, repeat serologic testing for syphilis is recommended for high risk groups.

F. Sexually transmitted disease. Testing for sexually transmitted diseases (eg, HIV, syphilis, hepatitis B surface antigen, chlamydia, gonorrhea) should be repeated in the third trimester in any woman at high risk for acquiring these infections; all women under age 25 years should be retested for Chlamydia trachomatis late in pregnancy.

G. Screening for group B streptococcus colonization at 35-37 weeks. All pregnant women should be screened for group B beta-hemolytic streptococcus (GBS) colonization with swabs of both the lower vagina and rectum at 35 to 37 weeks of gestation. The only patients who are excluded from screening are those with GBS bacteriuria earlier in the current pregnancy or those who gave birth to a previous infant with invasive GBS disease. These latter patients are not included in the screening recommendation because they should receive intrapartum antibiotic prophylaxis regardless of the colonization status.

H. Influenza immunization is recommended for women in the second and third trimesters and for high-risk women prior to influenza season regardless of stage of pregnancy.

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