Introduction
Women make up a significant proportion of the consumers of primary care. The majority of primary care services sought by women are pregnancy-related. Healthy pregnancy outcomes result from high-quality antenatal care, which ensures that healthcare practitioners, particularly the nurse-midwife, detect pregnancy disorders early for appropriate intervention. Consequently, the early detection and treatment of pregnancy disorders lead to fewer maternal and neonatal deaths. There were more than 300,000 maternal deaths resulting from problems related to pregnancy globally in 2015 (Tunçalp et al., 2017). For this reason, it is important to understand the care given to women who are pregnant in the third trimester.
Care During the Third Trimester of Pregnancy
The third trimester of pregnancy ranges from 28 weeks to 40 weeks gestation. The trimester is critical as most women experience discomfort on account of the growing fetus. Moreover, pregnancy complications worsen during this trimester. Therefore, the healthcare professionals, primarily nurse-midwife, design a plan of care for the pregnant woman. An essential aspect of care involves a schedule of antenatal visits every two weeks to detect complications early (Hersh, Megli, & Caughey, 2018). Therefore, close monitoring is essential in the third trimester of pregnancy.
Screening Tests
A series of examinations and screening is necessary for the pregnant woman’s optimum care in the third trimester. For example, a nurse-midwife attends to a pregnant woman in her 32-week gestation. The nurse asks the woman about any bothering symptoms and discomfort. Increased urinary urgency and difficulty in sleeping position becomes the chief concern of the pregnant woman. Consequently, the nurse explains and assures the pregnant female that the increased frequency of passing urine and discomfort is due to the growing fetus in the abdomen pressing the urinary bladder.
Moreover, the nurse noted edema in the feet and examined for facial edema. Subsequently, the nurse checked the fundal weight, blood pressure, fundal height, and fetal heart rate. The nurse also did a urine test to screen for hyperglycemia during pregnancy and pre-eclampsia toxemia; the results indicated that the client had a syphilis infection. Therefore, screening is essential to identify and manage conditions that complicate pregnancy.
Abnormal Screening Findings
Syphilis, a sexually transmitted infection, is known to complicate pregnancy. The World Health Organization ([WHO], 2017) recommends that healthcare professionals screen pregnant women on the first antenatal visit regardless of the gestation age. The aim is to prevent the impact of syphilis on pregnancy, including congenital syphilis and intrauterine fetal death. However, Hersh et al. (2018) established that repeating the screen for syphilis in pregnancy during any week of the third trimester refines maternal and neonatal health outcomes. Therefore, repeat syphilis screening is necessary to ensure detection and treatment.
Treatment of Syphilis in Pregnancy
Treatment of syphilis in pregnancy is imperative to avert health complications. Therefore, the patient will have to perform an ultrasound examination to check whether congenital syphilis has developed. Moreover, the client’s team will take a comprehensive history and physical examination to determine the clinical stage of syphilis. Pharmacological treatment involves the use of intramuscular injection of Benzathine penicillin G 2.4 mega units weekly for two weeks in early syphilis.
The recommended regimen for late syphilis is 2.4 mega units weekly for 4 to five weeks (WHO, 2017). Furthermore, the team should anticipate and plan for premature labor due to the Jarisch-Herxheimer reaction characterized by chills, fever, hypotension, tachycardia, skin lesions, nausea, and vomiting secondary to antibiotic treatment of syphilis infection. In addition, rapid plasma reagin (RPR) is done two weeks after completion of treatment to check for complete clearance of treponemes. Consequently, the client should be encouraged to abstain from sex or use condoms during the treatment period.
Conclusion
Appropriate care of pregnant women is paramount for a healthy society. Therefore, healthcare professionals should have the competencies to provide care to women. Moreover, stakeholders should design health interventions to detect and treat pregnancy complications to avert adverse consequences. Governments in collaboration with the health system should increase their efforts in making healthcare accessible and affordable. This is critical for detecting and managing problems related to pregnancy early.
References
Hersh, A. R., Megli, C. J., & Caughey, A. B. (2018). Repeat screening for syphilis in the third trimester of pregnancy: A cost-effectiveness analysis. Obstetrics and Gynecology, 132(3), 699–707. Web.
Tunçalp, O., Pena-Rosas, J. P., Lawrie, T., Bucagu, M., Oladapo, O. T., Portela, A., & Metin Gülmezoglu, A. (2017). WHO recommendations on antenatal care for a positive pregnancy experience-going beyond survival. BJOG: An International Journal of Obstetrics and Gynaecology, 124(6), 860–862. Web.
World Health Organization. (2017). WHO guideline on syphilis screening and treatment for pregnant women. Web.