Third trimester: Dangerous for the mother
The 5 main causes of maternal death appear in the third trimester of pregnancy, when the belly is already very large and the mother’s own body prioritizes the well-being of the baby over her own health. #KnowledgeIsSuccess and in this video Dr. Carlos Monsalve, expert in Maternal-Fetal Care at Creafam, explains what we can do to reduce complications.
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Introduction
As I told you in a previous video, the first trimester of pregnancy is the most dangerous for the baby, however for the mother it is the opposite, the health risks at the beginning are minimal, so much so that some do not even realize that they are pregnant… At most they might suspect it due to some nausea and discomfort that are more annoying than dangerous.
The real risk for the mother comes when the belly is already large, the organs are squeezed, the heart has to pump much more blood and the mother’s own body gives priority to the needs of the baby before its own, all this without mentioning the arrival of childbirth, which although it is something natural and beautiful, needs care to reduce the risks. The 5 main causes of maternal death appear in the third trimester and today I am going to explain each one because remember that Knowledge is Power and the third trimester of pregnancy is the most dangerous for the mother.
Risk #1: Hemorrhages
Worldwide, 800 pregnant women die every day from preventable causes, that’s one every 2 minutes and the most common cause is hemorrhage. Fortunately, at Creafam we have decades of experience, a well-coordinated medical team, high standards of care, as well as very strict follow-up protocols and, perhaps most importantly, all the infrastructure required.
But what happens in remote places or situations with little access to medicines and equipment for an emergency? Even if the doctor has a lot of experience, it can be difficult to diagnose and resolve the hemorrhage. What is the best thing you can do to reduce the risk? If you have suffered a fall, a blow or an accident, don’t try to act brave or endure the pain, tell everyone and don’t wait to see if what is happening to you improves on its own. Go to a consultation immediately and, as I say in each video, no bleeding is normal during pregnancy, much less in the third trimester!
It really saddens me every time I read a comment on YouTube asking what they should do because they’ve been bleeding for 2 or 3 days. Go for a checkup, it’s better to be safe than sorry.
Risk #2: Complications of childbirth
As I was saying at the beginning of the video, childbirth is natural and beautiful, especially when everything is in place and there are no complications. However, if the baby is born in a bad position, if there is little amniotic fluid, if there is anemia, hypertension or some chronic condition, the risk increases.
Usually the births we attend at Creafam are of patients who have been monitored since the beginning of pregnancy or at least a few months before. And we do complete studies! So we know perfectly how the mother and the baby are doing. If you have not had good control of your pregnancy or you go to an institution where they change doctors every time you go for a consultation, the worst thing you can do before giving birth is lie to your doctor or hide information from him.
If we doctors ask questions about your health or the monitoring you have had, it is not to scold you, it is to understand what we are going to face. Many times patients tell us that they have gone to regular check-ups, and that they have had all the tests done, and that they were told that everything is perfect, and in the end we discover that they don’t even know that they were going to have twins and that one is much more developed than the other, or they didn’t know that the IUD was still inside the uterus, or that the mother had severe anemia, or they say that they have only had one cesarean section and in reality they have had several.
Obviously as a doctor you notice all these details from the moment you are examining the patient, but please, the phrase that knowledge is power does not only apply to patients, the more information your doctor has, the better the birth will go.
Risk #3: Eclampsia
Pregnancy demands a lot from the mother’s body. It increases the volume of circulating blood, so the heart has to work much harder, and it is no surprise that in the second trimester many pregnant women develop preeclampsia, which is what we call hypertension with proteinuria, that is, when proteins appear in the urine test and it means that the kidneys are failing.
It is a fact that human beings do not give high blood pressure the seriousness it deserves. Ask anyone with high blood pressure and they will tell you: “It’s okay, sometimes I feel a little bad but then it goes away” and that is the problem, that it is a general malaise. When you twist an ankle you immediately limp and stop putting weight on your foot because it hurts. When you get a cough you quickly buy a syrup or make yourself a tea to feel better.
Well, high blood pressure damages your entire body… Each and every one of the arteries in your body harden, narrow and their walls weaken, producing aneurysms. An aneurysm is like a bulb that can easily burst. If we ignore preeclampsia, eclampsia will surely follow, and eclampsia has serious and fatal consequences.
The fatal consequences are obvious and evident: heart attack, stroke, kidney failure and aneurysms. But the serious consequences and symptoms are often ignored because we think it is something normal that can come with age: having bad arteries, blurred vision, retinal damage, heart disease, diabetes, mental deterioration such as memory problems, forgetting words, confusion or even dementia. We attribute all of that to age! And sometimes it is not so much age, but high blood pressure that has not been controlled.
In the third trimester, you must definitely have your blood pressure checked and have a general urine test done.
Risk #4: Sepsis and postpartum infections
According to the World Health Organization, maternal sepsis is the third cause of death in pregnant women and most commonly occurs in the period after delivery, so it is essential to deliver the baby under the best hygiene conditions, as well as to have the greatest care and prophylaxis for at least 40 days after delivery, during the period we call puerperium or quarantine. The most common infections are bacterial but we should never rule out viruses, fungi or parasites.
The usual symptoms of an infection are: changes in body temperature, such as chills, high fever or unusually low temperature, palpitations or accelerated heart rate, abnormal vaginal discharge, vertigo or dizziness, rashes, irritation or changes in skin color, sneezing with cough or with a lot of phlegm. A mild infection can be controlled with medication, but when it gets worse the immune system goes out of control and attacks all cells, including those of our own body, causing failure in various organs. This extreme condition is what we call sepsis.
If you have symptoms of an infection, please go to your doctor immediately. Even severe cases of sepsis can be controlled, but intense monitoring, intravenous fluids, and antibiotics are needed. In some cases, we even have to give oxygen and medication to support various organs. You have to go to a hospital. Don’t let time pass.
Risk #5: Clandestine abortion
In this video I have talked about the risks during the third trimester, and although clandestine abortion usually occurs in the first weeks of pregnancy, it is still one of the main causes of maternal death and that is why I want to mention it. I know it is a controversial topic and at Creafam we will always prioritize protecting life but knowledge is power and I just want to share two facts with you:
- Clandestine abortion is one of the main causes of maternal death, obviously there are no exact statistics but it should be ranked between fourth and sixth place in risk in Mexico.
- Since 2021, the Supreme Court of Justice decriminalized abortion and most states have updated their laws to reflect this decision.
Please do not risk your life, look for legal, free and safe options through your local health department.
Farewell
Thank you moms and dads for joining us in this video. We hope you can share it with your loved ones because together we can further reduce third trimester deaths. If you have questions or would like us to review your case, remember that we have virtual or in-person consultations.
Perinatology, invasive techniques and obstetric ultrasound.
Hospital Universitario La Fe, Valencia, España.