What are the recommended prenatal care and interventions at 33 weeks of gestation?

From the Guidelines

At 33 weeks gestation, prenatal care should prioritize monitoring for fetal growth restriction (FGR) and preparing for potential early delivery, with a focus on maternal and fetal health.

Key Recommendations

• Regular prenatal visits should occur every two weeks, with blood pressure checks, weight monitoring, urine testing for protein, and fundal height measurement to track fetal growth 1.
• Fetal movement monitoring should continue, with patients advised to count kicks daily and report any significant decrease in movement.
• Providers should assess fetal position through Leopold's maneuvers to determine if the baby is head-down (cephalic) or breech.
• Ultrasound may be performed if there are concerns about fetal growth, position, or amniotic fluid levels, and serial umbilical artery Doppler assessment should be performed to assess for deterioration in cases of FGR 1.
• Delivery at 33-34 weeks of gestation is recommended for pregnancies with FGR and absent end-diastolic velocity 1.

Additional Considerations

• Patients should receive education about preterm labor signs, including regular contractions, pelvic pressure, low back pain, and increased vaginal discharge.
• Tdap vaccination is recommended between 27-36 weeks to provide passive immunity to the newborn against pertussis.
• Nutritional guidance should emphasize adequate protein, iron, calcium, and folic acid intake, with continued prenatal vitamin supplementation.
• Patients should also begin finalizing their birth plan and packing a hospital bag as delivery approaches in the coming weeks.

Fetal Growth Restriction Management

• The use of population-based fetal growth references, such as Hadlock, is recommended in determining fetal weight percentiles 1.
• Fetal diagnostic testing, including chromosomal microarray analysis, should be offered when FGR is detected and a fetal malformation, polyhydramnios, or both are also present, regardless of gestational age 1.
• Antenatal corticosteroids should be used if delivery is anticipated before 33 6/7 weeks of gestation 1.

From the Research

Prenatal Care at 33 Weeks of Gestation

At 33 weeks of gestation, prenatal care is crucial for monitoring the health of both the mother and the fetus. The following are some recommended interventions:

• Tocolytic therapy: For women experiencing preterm labor, tocolytic therapy with nifedipine or indomethacin may be recommended to delay delivery and reduce the risk of preterm birth 2, 3, 4.
• Progesterone supplementation: Vaginal progesterone may be prescribed in addition to tocolytic therapy to help prolong pregnancy and reduce the risk of preterm birth 2.
• Fetal monitoring: Regular fetal monitoring, including non-stress tests and biophysical profiles, may be performed to assess fetal well-being 5.
• Maternal health assessments: Maternal health assessments, including blood pressure checks and urine tests, may be performed to monitor for any potential complications, such as preeclampsia or gestational diabetes 5.
• Screening for group B Streptococcus: Screening for group B Streptococcus may be performed between 36 and 37 weeks of gestation, and intrapartum antibiotic prophylaxis may be initiated to decrease the risk of neonatal infection 5.

Interventions for Preterm Labor

For women experiencing preterm labor at 33 weeks of gestation, the following interventions may be recommended:

• Nifedipine: Nifedipine may be prescribed as a tocolytic agent to help delay delivery and reduce the risk of preterm birth 2, 3, 4.
• Indomethacin: Indomethacin may be prescribed as a tocolytic agent, either alone or in combination with nifedipine, to help delay delivery and reduce the risk of preterm birth 3.
• Combination therapy: Combination therapy with nifedipine and indomethacin may be more effective than monotherapy with either of these two medications for inhibiting preterm labor and delaying delivery 3.

Key Considerations

The following are some key considerations for prenatal care at 33 weeks of gestation:

• Regular prenatal visits: Regular prenatal visits are essential for monitoring the health of both the mother and the fetus 5.
• Screening for potential complications: Screening for potential complications, such as preeclampsia or gestational diabetes, is crucial for identifying and managing any potential risks 5.
• Tocolytic therapy: Tocolytic therapy may be recommended for women experiencing preterm labor to help delay delivery and reduce the risk of preterm birth 2, 3, 4.