The third visit should take place around 30 - 32 weeks and is expected to take 20 minutes.

Objectives of the Third Visit

  • Address complaints and concerns.
  • Assess for multiple pregnancies, assess foetal well-being.
  • Review individualised birth plan and complication readiness including advice to access skilled attendance in case of onset of labour, special care and treatment for HIV-positive women based on the National Guideline for PMTCT of HIV in Ethiopia.
  • Advice on family planning and breastfeeding.
  • Decide on the need for referral based on updated risk assessment.

a) History

  • Personal history:

(Note any changes or events since the second visit).

  • Medical history:
  • Review relevant issues of medical history as recorded at first and second visits.
  • Ensure existence of diseases, injuries or other conditions and additional histories for HIV-positive women since the first and the second visit.
  • Note intake of medicines other than iron and foliate.
  • Compliance with iron intake.
  • Note other medical consultations and hospitalisation.
  • Obstetric history:

(Review relevant issues of obstetric history as recorded during the first visit and checked during the second one)

  • Vaginal bleeding and vaginal discharge.
  • Dysuria, frequency and urgency during micturition.
  • Severe or persistent headache or blurred vision.
  • Difficulty breathing.
  • Fever.
  • Severe abdominal pain.
  • Foetal movement; note time of first recognition in the medical record.
  • Other specific symptoms or events such as opportunistic infections in HIV-positive women.
  • Changes in body features or physical capacity, observed by the woman herself, her partner or other family members
  • Habits regarding alcohol, smoking and others.

b) Physical Examination

  • Measure and record vital signs (BP, PR, RR, weight gain or loss and temperature).
  • Measure uterine height record on the graph.
  • Palpate abdomen for detect multiple foetuses.
  • Auscultate fetal heartbeat (using the fetoscope).
  • Check for generalised oedema.
  • Check for other alarming signs of disease such as shortness of breath and cough etc.
  • Check for bleeding or spotting (Never do a vaginal examination in these cases!).
  • Do breast examination for abnormality.

c) Implement These Interventions

  • Ensure compliance of iron and foliate and refill as needed.
  • Provide tetanus toxoid injection as needed.

d) Advice, Questions and Answers, and Scheduling the Next Appointment

  • Repeat advice given at first and second visits.
  • Give advice on steps to be taken in case labour starts.
  • Questions and answers: give sufficient time for free communication and discussion.
  • Reconfirm written information on whom to call and where to go in case of emergency or any other problem.
  • Ensure availability of transport in case of an emergency like the onset of labour.
  • Provide advice on breastfeeding, contraception and importance of the postpartum visit.
  • Schedule appointment for the fourth visit at 36-38 weeks.

e) Maintain Complete Records

  • Complete the integrated client card.
  • Complete the appointment card.
  • Enter information on the registration logbook.

Last modified: Tuesday, 21 February 2017, 4:10 PM