The third visit
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)
- Record symptoms and events since the second visit; Ask about:
- 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