What warning signs should the nurse teach the client to observe for during the third trimester

You may wonder what symptoms during pregnancy warrant immediate medical attention and what symptoms can wait until your next prenatal visit.

Always ask your doctor at your visits about your concerns. But keep in mind some symptoms do need swift attention.

Bleeding means different things throughout your pregnancy. “If you are bleeding heavily and have severe abdominal pain and menstrual-like cramps or feel like you are going to faint during first trimester, it could be a sign of an ectopic pregnancy,” Peter Bernstein, MD, ob-gyn professor at New York's Albert Einstein College of Medicine and Montefiore Medical Center, says. Ectopic pregnancy, which occurs when the fertilized egg implants somewhere other than the uterus, can be life-threatening.

Heavy bleeding with cramping could also be a sign of miscarriagein first or early second trimester. By contrast, bleeding with abdominal pain in the third trimester may indicate placental abruption, which occurs when the placenta separates from the uterine lining.

“Bleeding is always serious,” women’s health expert Donnica Moore, MD, says. Any bleeding during pregnancy needs immediate attention. Call your doctor or go to the emergency room.

It's very common to have some nausea when you're pregnant. If it gets to be severe, that may be more serious.

“If you can’t eat or drink anything, you run the risk of becoming dehydrated,” Bernstein says. Being malnourished and dehydrated can harm your baby.

If you experience severe nausea, tell your health care provider. Your doctor may prescribe medication or advise changing your diet.

What does it mean if your previously active baby seems to have less energy? It may be normal. But how can you tell?

Some troubleshooting can help determine if there is a problem. Bernstein suggests that you first drink something cold or eat something. Then lie on your side to see if this gets the baby moving.

Counting kicks can also help, Nicole Ruddock, MD, assistant professor of maternal and fetal medicine at University of Texas Medical School at Houston, says. “There is no optimal or critical number of movements,” she says, “but generally you should establish a baseline and have a subjective perception of whether your baby is moving more or less. As a general rule, you should have 10 or more kicks in two hours. Anything less should prompt a phone call to your doctor.”

Bernstein says to call your doctor as soon as possible. Your doctor has monitoring equipment that can be used to determine if the baby is moving and growing appropriately.

Contractions could be a sign of preterm labor. “But a lot of first-time moms may confuse true labor and false labor,” Ruddock says. False labor contractions are called Braxton-Hicks contractions. They’re unpredictable, non-rhythmic, and do not increase in intensity. “They will subside in an hour or with hydration,” Ruddock says. “But regular contractions are about 10 minutes apart or less and increase in intensity.”

If you're in your third trimester and think you're having contractions, call your doctor right away. If it is too early for the baby to be born, your doctor may be able to stop labor.

You walk into the kitchen for a drink and feel a flood of water rush down your legs. “Your water could have broken,” Ruddock says, “but during pregnancy the enlarged uterus can cause pressure on your bladder too. So it could be urine leakage.” Ruddock says that sometimes water breaking is a dramatic gush of fluid, but other times it is more subtle.

“If you are not sure if it is urine versus a true rupture of the membrane, go to the bathroom and empty your bladder," she says. "If the fluid continues, then you have broken your water.” Call your doctor or go to the hospital.

These symptoms could be a sign of preeclampsia. That’s a serious condition that develops during pregnancy and is potentially fatal. The disorder is marked by high blood pressure and excess protein in your urine that typically occurs after the 20th week of pregnancy.

“Call your doctor right away and get your blood pressure tested,” Bernstein says. “Good prenatal care can help catch preeclampsia early.”

Our experts say it’s important for pregnant women to get the flu vaccine since pregnant women are more likely to get sick and have serious complications from the flu than other women during flu season.

But if you do get the flu, "don’t rush into a hospital or doctor’s office where you can spread it to other pregnant women," Bernstein says. "Call your doctor first."